AIMS:Lack of adherence to smoking cessation medication regimens is assumed to play a significant role in limiting their effectiveness. This study aimed to assess evidence for this assumption. METHODS:A systematic search was conducted, supplemented by expert consultation, of papers reporting on randomized trials and observational studies examining the association between adherence to cessation medication and the success of quit attempts. To rule out reverse causality, only studies where adherence was assessed prior to relapse were included. Five studies met the inclusion criteria and results were extracted independently by two researchers. Heterogeneity between studies precluded a pooled analysis of the data. RESULTS:Studies varied widely with regard to both the definition of adherence and outcome measures. The included studies only addressed adherence to nicotine replacement therapy. One study of lozenge use found that the amount of medication used between 1 and 2 weeks after the quit date predicted abstinence at 6 weeks [adjusted odds ratio (OR) for 'high' versus 'low' lozenge use 1.25; 95% confidence interval (CI) = 1.05-1.50; P < 0.02]. Similarly, one study found a significant impact of oral nicotine consumption during the first week on abstinence at 4 weeks (adjusted OR per additional mg/day = 1.05; CI = 1.01-1.10). Another study found that participants using nicotine replacement therapy for at least 5 weeks were significantly more likely to self-report continuous abstinence at 6 months. The remaining two studies failed to find a significant effect of treatment duration on outcome at 1 and 2 years but had very low power to detect such an effect. CONCLUSIONS:There is modest evidence to support the assumption that lack of adherence to nicotine replacement therapy regimens undermines effectiveness in clinical studies.

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目的:假设缺乏坚持戒烟药物方案在限制其有效性方面起着重要作用。这项研究旨在评估这一假设的证据。
方法:进行了系统的搜索,并有专家咨询的补充,报告了有关随机试验和观察性研究的论文,这些研究探讨了坚持戒断药物与戒烟成功之间的关系。为了排除反向因果关系,仅包括在复发前评估依从性的研究。五项研究符合纳入标准,结果由两名研究人员独立提取。研究之间的异质性排除了对数据进行汇总分析的可能性。
结果:关于依从性的定义和结果测量的研究差异很大。纳入的研究仅针对坚持尼古丁替代疗法。一项关于锭剂使用的研究发现,戒烟日期后1至2周内使用的药物量预计在6周时会出现戒断[对于“高”锭剂和“低”锭剂使用,校正后的优势比(OR)为1.25; 95%置信区间(CI)CI = 1.05-1.50; P <0.02]。同样,一项研究发现在第一个星期口服尼古丁对禁食4周有显着影响(调整后的OR /每增加1 mg /天= 1.05; CI = 1.01-1.10)。另一项研究发现,使用尼古丁替代疗法至少5周的参与者在6个月时自我报告连续禁欲的可能性更高。其余两项研究未能发现治疗持续时间对1年和2年结局有显着影响,但检测这种效果的能力非常低。
结论:有少量证据支持以下假设:缺乏对尼古丁替代疗法的依从性破坏了临床研究的有效性。

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