Rédacteurs : Johan Nguyen, Jean-Luc Gerlier, Claude Pernice

Sommaire

smoking cessation:

Tabagisme : évaluation du sevrage par acupuncture

Articles connexes : évaluation du taiji-qigong - évaluation de la pharmacopée -

1. Systematic Reviews and Meta-Analysis

☆☆☆ Evidence for effectiveness and a specific effect of acupuncture
☆☆ Evidence for effectiveness of acupuncture
Limited evidence for effectiveness of acupuncture
Ø No evidence or insufficient evidence

1.1. Generic Acupuncture

1.1.1. Wang 2019

Wang JH, van Haselen R, Wang M, Yang GL, Zhang Z, Friedrich ME, Wang LQ, Zhou YQ, Yin M, Xiao CY, Duan AL, Liu SC6, Chen B, Liu JP. Acupuncture for smoking cessation: A systematic review and meta-analysis of 24 randomized controlled trials. Tob Induc Dis. 2019. [201455].

IntroductionWe evaluate the effectiveness and safety of transdermal acupuncture by needles for smoking cessation.
Methods A literature search for randomized controlled trials (RCTs) was performed in seven electronic databases from inception to February 2017. Meta-analysis was conducted using Revman 5.3.0 software. We used either a random effects model (REM) or a fixed effects model (FEM) for pooling data according to the result of a heterogeneity test (defined as significant if I2>75%). Trial sequential analysis (TSA) was applied by TSA 0.9.5.10 Beta software.
ResultsTwenty-four trials involving 3984 participants were included. The methodological quality was generally low. With regard to smoking abstinence, meta-analysis showed acupuncture was more effective compared to no intervention/waiting list for short-term (4 weeks) cessation (1 trial, RR=2.37, 95% 1.41, 3.97) and long-term (longer than 6 months) (2 trials, RR=2.66, 95% CI: 1.50, 4.70). Compared to acupuncture/auricular acupressure alone, acupuncture plus auricular acupressure showed more benefit for short-term cessation (3 trials, RR=1.52, 95% CI: 1.03, 2.25). Acupuncture plus auricular acupressure was more effective compared to sham acupuncture plus sham auricular acupressure for short-term cessation (3 trials, RR=2.50, 95% CI: 1.44, 4.33) and long-term (2 trials, RR=3.61, 95% CI: 1.37, 9.48). Acupuncture in combination with counseling, educational smoking cessation program or moxibustion had more benefit compared to acupuncture for short-term cessation (3 trials, RR=0.75, 95% 0.63, 0.91) and long-term (2 trials, RR=0.77, 95% CI: 0.56, 1.05), and TSA illustrated the cumulative Z-curve of this comparison for long-term across the traditional boundary of 5% significance and monitoring boundaries. No serious adverse events occurred.
CONCLUSIONS Acupuncture combined with counseling, educational smoking cessation program or moxibustion was more effective than acupuncture as monotherapy with regard to long-term smoking cessation. Further, high quality trials are needed to confirm the result.

1.1.2. Liu 2015 ☆☆

Liu Z, Wang Y, Wu Y, Yang J. [Condition and effectiveness evaluation of acupuncture for smoking cessation]. Chinese Acupuncture & Moxibustion. 2015;35(8):851-7. [186929].

ObjectiveThe effectiveness of acupuncture for smoking cessation was systematically evaluated in this paper.
Methods By using computer retrieval in Chinese national knowledge infrastructure (CNKI), WANFANG database, VIP database, PubMed, ScienceDirect and Springer, the randomized controlled trials (RCTs) regarding acupuncture for smoking cessation from January of 1983 to December of 2013 were collected; by using Table of Standardized Report Factors for Acupuncture RCTs, each inclusive RCT was evaluated; and by using RevMan 5. 2 software, the Meta-analysis was performed.
Results Totally 24 RCTs were included, involving 3084 cases of smoking. The result of literature quality assessment showed that the average score was 25. 71 points without low-quality RCT which had a score of less than 16 points. The Meta-analysis showed that acupuncture could significantly increase the short-time abstinence rate [RR=1. 48, 95% CI (1. 18,1. 84), Z=3. 47, P<0. 0005] and number of cigarettes smoked daily [RR=4. 35, 95% CI (2. 03, 6. 66), Z=3. 68, P<0. 001] and FTND [RR=2. 37, 95% CI (1. 88, 2. 86), Z= 9. 44, P<0. 00001], however, it could not increase the long-time abstinence rate [RR=1. 40, 95% Cl (0. 90, 2.17), Z=1. 49, P>0. 05].
Conclusions Compared with other treatment, acupuncture has positive advantages on short-time abstinence rate, however, its effect on long-time abstinence rate needs to be verified by high-quality, large-sample and multi-center RCT in the future.

1.1.3. White 2014 ☆

White AR, Rampes H, Liu JP, Stead LF, Campbell J. Acupuncture and related interventions for smoking cessation. Cochrane Database Syst Rev. 2014. [170682]

Background Acupuncture and related techniques are promoted as a treatment for smoking cessation in the belief that they may reduce nicotine withdrawal symptoms.
Objectives The objectives of this review are to determine the effectiveness of acupuncture and the related interventions of acupressure, laser therapy and electrostimulation in smoking cessation, in comparison with no intervention, sham treatment, or other interventions.
Methods Search methods: We searched the Cochrane Tobacco Addiction Group Specialized Register (which includes trials of smoking cessation interventions identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, and PsycINFO) and AMED in October 2013. We also searched four Chinese databases in September 2013: Sino-Med, China National Knowledge Infrastructure, Wanfang Data and VIP. Selection criteria: Randomized trials comparing a form of acupuncture, acupressure, laser therapy or electrostimulation with either no intervention, sham treatment or another intervention for smoking cessation. Data collection and analysis: We extracted data in duplicate on the type of smokers recruited, the nature of the intervention and control procedures, the outcome measures, method of randomization, and completeness of follow-up. We assessed abstinence from smoking at the earliest time-point (before six weeks) and at the last measurement point between six months and one year. We used the most rigorous definition of abstinence for each trial, and biochemically validated rates if available. Those lost to follow-up were counted as continuing smokers. Where appropriate, we performed meta-analysis pooling risk ratios using a fixed-effect model.
Results We included 38 studies. Based on three studies, acupuncture was not shown to be more effective than a waiting list control for long-term abstinence, with wide confidence intervals and evidence of heterogeneity (n = 393, risk ratio [RR] 1.79, 95% confidence interval [CI] 0.98 to 3.28, I² = 57%). Compared with sham acupuncture, the RR for the short-term effect of acupuncture was 1.22 (95% CI 1.08 to 1.38), and for the long-term effect was 1.10 (95% CI 0.86 to 1.40). The studies were not judged to be free from bias, and there was evidence of funnel plot asymmetry with larger studies showing smaller effects. The heterogeneity between studies was not explained by the technique used. Acupuncture was less effective than nicotine replacement therapy (NRT). There was no evidence that acupuncture is superior to psychological interventions in the short- or long-term. There is limited evidence that acupressure is superior to sham acupressure for short-term outcomes (3 trials, n = 325, RR 2.54, 95% CI 1.27 to 5.08), but no trials reported long-term effects, The pooled estimate for studies testing an intervention that included continuous auricular stimulation suggested a short-term benefit compared to sham stimulation (14 trials, n = 1155, RR 1.69, 95% CI 1.32 to 2.16); subgroup analysis showed an effect for continuous acupressure (7 studies, n = 496, RR 2.73, 95% CI 1.78 to 4.18) but not acupuncture with indwelling needles (6 studies, n = 659, RR 1.24, 95% CI 0.91 to 1.69). At longer follow-up the CIs did not exclude no effect (5 trials, n = 570, RR 1.47, 95% CI 0.79 to 2.74). The evidence from two trials using laser stimulation was inconsistent and could not be combined. The combined evidence on electrostimulation suggests it is not superior to sham electrostimulation (short-term abstinence: 6 trials, n = 634, RR 1.13, 95% CI 0.87 to 1.46; long-term abstinence: 2 trials, n = 405, RR 0.87, 95% CI 0.61 to 1.23).
Authors' conclusions Although pooled estimates suggest possible short-term effects there is no consistent, bias-free evidence that acupuncture, acupressure, or laser therapy have a sustained benefit on smoking cessation for six months or more. However, lack of evidence and methodological problems mean that no firm conclusions can be drawn. Electrostimulation is not effective for smoking cessation. Well-designed research into acupuncture, acupressure and laser stimulation is justified since these are popular interventions and safe when correctly applied, though these interventions alone are likely to be less effective than evidence-based interventions.

1.1.4. Cheng 2012 ☆☆

Cheng HM, Chung YC, Chen HH, Chang YH, Yeh ML. Systematic review and meta-analysis of the effects of acupoint stimulation on smoking cessation American Journal of Chinese Medicine. 2012;40(3):429-42. [157157]

Objectives Smoking represents a serious worldwide public health problem because of its close association with the development of chronic disease and cancer. Acupoint stimulation has been used as treatment mode for smoking cessation but its efficacy remains controversial. This systematic review and meta-analysis aimed to determine the effects of acupoint stimulation on smoking cessation rate and daily cigarette consumption.
Methods Electronic literature searches in eight electronic databases up to March 2011 were performed to identify acupoint stimulation for smoking cessation. The outcomes assessed were smoking cessation rate and cigarette consumption. We assessed abstinence from smoking at the earliest and last measured time points, and at the 3- and 6-month follow-ups. Meta-analysis was performed using CMA software.
Results A total of 20 RCTs were included in the meta-analysis. A significant effect of acupoint stimulation was found in smoking cessation rates and cigarette consumption at immediate, 3- and 6-month follow-ups, with effect sizes 1.24 (95%CI=1.07∼1.43, p=0.003), -2.49 (95%CI= -4.65∼ -0.34, p = 0.02), 1.70 (95%CI = 1.17∼2.46, p = 0.01), and 1.79 (95%CI= 1.13 ∼ 2.82, p= 0.01), respectively.
Concluions Multi-modality treatments, especially acupuncture combined with smoking cessation education or other interventions, can help smokers to eschew smoking during treatment, and to avoid relapse after treatment.

1.1.5. Kim 2012 ~

Kim SS, Chen W, Kolodziej M, Wang X, Wang VJ, Ziedonis D. A Systematic Review of Smoking Cessation Intervention Studies in China. Nicotine Tob Res. 2012;14(8):891-9. [169125].

Objectives China has the highest number of tobacco smokers among the world's nations; however, no systematic review has been conducted of clinical trials on the efficacy of smoking cessation interventions in China. This paper summarizes findings of studies in order to compare the effect of pharmacotherapy, counseling, and Traditional Chinese Medicine (TCM) approaches on the abstinence rate.
Methods Clinical trials of smoking cessation interventions published in English or Chinese were extracted from an electronic search of PubMed and WanFang databases. The search yielded 234 studies from the PubMed and 78 studies from the WanFang.
Results Twenty-nine studies were included in this review. Of these, 11 (37.9%) were randomized controlled trials (RCTs) that assessed the following approaches: counseling (5 studies), TCM (3 studies), pharmacotherapy (1 study), a combination of pharmacotherapy and counseling (1 study), and physician advice (1 study). Pharmacotherapy alone or in combination with counseling generally resulted in a higher abstinence rate than counseling alone. TCM techniques such as acupuncture and ear point seed pressure yielded a much higher abstinence rate than pharmacotherapy and counseling . Findings are inconclusive, however, because most of the TCM studies were noncontrolled trials and did not provide a definition of “abstinence.” Findings on the effectiveness of physician advice to quit smoking were also inconclusive.
Conclusions A review of smoking cessation studies revealed that pharmacotherapy was effective in China. More RCTs of TCM approaches and physician advice are needed with long-term follow-up assessments and biochemical verification of self-reported abstinence before these approaches are adopted as evidence-based smoking cessation interventions in China.

1.1.6. White 2011 Ø

White AR, Rampes H, Liu JP, Stead LF, Campbell J. Acupuncture and related interventions for smoking cessation. Cochrane Database Syst Rev. 2011;19. [156156]

BackgroundAcupuncture and related techniques are promoted as a treatment for smoking cessation in the belief that they may reduce nicotine withdrawal symptoms.
ObjectivesThe objectives of this review are to determine the effectiveness of acupuncture and the related interventions of acupressure, laser therapy and electrostimulation in smoking cessation, in comparison with no intervention, sham treatment, or other interventions.
Methods Search strategy: We searched the Cochrane Tobacco Addiction Group specialized register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, BIOSIS Previews, PsycINFO, Science Citation Index, AMED, Acubriefs in November 2010; and four Chinese databases: Chinese Biomedical Database, China National Knowledge Infrastructure, Wanfang Data and VIP in November 2010. Selection criteria: Randomized trials comparing a form of acupuncture, acupressure, laser therapy or electrostimulation with either no intervention, sham treatment or another intervention for smoking cessation. Data collection and analysis: We extracted data in duplicate on the type of smokers recruited, the nature of the intervention and control procedures, the outcome measures, method of randomization, and completeness of follow up. We assessed abstinence from smoking at the earliest time-point (before six weeks), and at the last measurement point between six months and one year. We used the most rigorous definition of abstinence for each trial, and biochemically validated rates if available. Those lost to follow up were counted as continuing smokers. Where appropriate, we performed meta-analysis using a fixed-effect model.
Main resultsWe included 33 reports of studies. Compared with sham acupuncture, the fixed-effect risk ratio (RR) for the short-term effect of acupuncture was 1.18 (95% confidence interval 1.03 to 1.34), and for the long-term effect was 1.05 (CI 0.82 to 1.35). The studies were not judged to be free from bias. Acupuncture was less effective than nicotine replacement therapy (NRT). There was no evidence that acupuncture is superior to waiting list, nor to psychological interventions in short- or long-term. The evidence on acupressure and laser stimulation was insufficient and could not be combined. The evidence suggested that electrostimulation is not superior to sham electrostimulation.
Authors' conclusionsThere is no consistent, bias-free evidence that acupuncture, acupressure, laser therapy or electrostimulation are effective for smoking cessation, but lack of evidence and methodological problems mean that no firm conclusions can be drawn. Further, well designed research into acupuncture, acupressure and laser stimulation is justified since these are popular interventions and safe when correctly applied, though these interventions alone are likely to be less effective than evidence-based interventions.

1.1.7. White 2006 Ø

White A, Rampes H, Campbell J. Acupuncture and related interventions for smoking cessation. Cochrane Database Syst Rev. 2006;1:CD000009. [141084]

BackgroundAcupuncture and related techniques are promoted as a treatment for smoking cessation in the belief that they may reduce nicotine withdrawal symptoms.
ObjectivesThe objectives of this review are to determine the effectiveness of acupuncture and the related interventions of acupressure, laser therapy and electrostimulation, in smoking cessation in comparison with no intervention, sham treatment, or other interventions.
Methods Search strategy: We searched the Cochrane Tobacco Addiction Group specialized register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, BIOSIS Previews, PsycINFO, Science and Social Sciences Citation Index, AMED and CISCOM. Date of last search January 2005. Selection criteria: Randomized trials comparing a form of acupuncture, acupressure, laser therapy or electrostimulation with either no intervention, sham treatment or another intervention for smoking cessation. Data collection and analysis: We extracted data in duplicate on the type of smokers recruited, the nature of the acupuncture and control procedures, the outcome measures, method of randomization, and completeness of follow up. We assessed abstinence from smoking at the earliest time-point (before six weeks), and at the last measurement point between six months and one year. We used the most rigorous definition of abstinence for each trial, and biochemically validated rates if available. Those lost to follow up were counted as continuing smokers. Where appropriate, we performed meta-analysis using a fixed-effect model.
Main results We identified 24 reports of studies. The only comparison for which there were sufficient studies to combine meaningfully was acupuncture compared with sham acupuncture. The fixed-effect odds ratio (OR) for the short-term effect was 1.36 (95% confidence interval 1.07 to 1.72), but the studies are heterogeneous and the result is strongly influenced by one individual positive study. The significant short-term effect was lost with the random-effects model for pooling, or by removing the outlying study that led to heterogeneity. The long-term result shows no effect of acupuncture compared with sham acupuncture. There was no consistent evidence that acupuncture is superior to no treatment, and no evidence that the effect of acupuncture was different from that of other anti-smoking interventions, or that any particular acupuncture technique is superior to other techniques.
Authors' conclusionsThere is no consistent evidence that acupuncture, acupressure, laser therapy or electrostimulation are effective for smoking cessation, but methodological problems mean that no firm conclusions can be drawn. Further research using frequent or continuous stimulation is justified.

1.1.8. Castera 2002 ☆☆☆

Castera P, Nguyen J, Gerlier JL. L ' Acupuncture est-elle bénéfique dans le sevrage tabagique, son action est-elle spécifique ? Une méta-analyse.. Acupuncture et Moxibustion. 2002;1(3-4):76. (fra). [109844]

Problématique L'acupuncture est reconnue populairement comme une méthode aidant les fumeurs à arrêter le tabac. Cependant, les méta-analyses les plus récentes ne paraissent pas apporter de preuve en faveur de cette hypothèse.
Objectifs Les auteurs de cette nouvelle revue ont pour but de déterminer 1) si l'acupuncture est supérieure a une absence d'intervention ou à une intervention minimale et 2) si elle est supérieure a l'acupuncture-factice (dite placebo).
Méthodes Stratégie d'identification des études : les auteurs ont complété la recherche documentaire effectuée par White AR et al (la dernière méta-analyse publiée) par une recherche dans les bases de données françaises spécialisées en acupuncture (Acudoc2, Acudoc2-ECR et Acubase) jusqu'en juin 2002. Critères d'inclusion des études : tous les essais comparatifs randomises (ECR) comparant l'acupuncture à une absence d'intervention, à une intervention minimale ou à l'acupuncture factice pour arrêter de finir. Extraction des données et analyse : les données nécessaires aux méta-analyses ont été extraites selon les possibilités, au point de mesure le plus précoce (moins de 6 semaines après la fin du traitement), à 6 mois (jusqu'à 9 mois) et a 12 mois. Tous les patients sortis de l'essai ou perdus de vue ont été considérés comme fumeurs persistants. Les données fournies par l'essai ont donc été éventuellement recalculées pour avoir des résultats “en intention de traiter”. Arrêt continu du tabac a été préfère à l'absence de tabagisme au moment de la mesure, quand cette donnée était disponible. Dans tous les cas l'odds ratio (OR) a été calcule en utilisant le modelé statistique paramétrique (fixed effect). Le modèle statistique non paramétrique (random effects) a également été utilise pour vérifier la solidité des résultats en cas d'hétérogénéité. L'intervalle de confiance a été choisi a 95%. Le logiciel de méta-analyse utilisé est Revman 4.1.
Résultats 18 essais sont inclus, dont un nouveau par rapport aux méta-analyses précédentes. L'acupuncture est significativement supérieure à une absence d'intervention ou à une intervention minimale à moins de 6 semaines de suivi (OR 3.31, 95% CI 2.34 à 4.68) et à réévaluation la plus tardive, entre 6 mois et 12 mois (OR 2.95, 95% CI 1.91 à 4.57). L'acupuncture est significativement supérieure à l'acupuncture-factice a moins de 6 semaines de suivi (OR 1.31, 95% CI 1.07 à 1.60), à 6 mois de suivi (OR 1.82, 95% CI 1.14 à 2.88), mais pas à 12 mois de suivi (OR 1.07, 95% CI 0.76 à 1.50) ou à évaluation la plus tardive (OR 1.16 95% CI 0.85 à 1.59).
Conclusion des auteurs L'acupuncture apparait bénéfique dans le sevrage tabagique, justifiant son utilisation dans cette indication. Une action spécifique est mise en évidence.

1.1.9. White 2002 Ø

White AR et al. Acupuncture for smoking cessation. Cochrane Database Syst Rev. 2002;2:9. (eng). [131627]

Background Acupuncture and related techniques are promoted as a treatment for smoking cessation in the belief that they may reduce nicotine withdrawal symptoms.
Objectives The objective of this review is to determine the effectiveness of acupuncture and the allied therapies of acupressure, laser therapy and electrostimulation, in smoking cessation in comparison with: a) sham treatment, b) other interventions, or c) no intervention. SEARCH STRATEGY: We searched the Cochrane Tobacco Addiction Group trials register, Cochrane Controlled Trials Register, Medline, Embase, BIOSIS Previews, PsycINFO, Science and Social Sciences Citation Index, AMED and CISCOM. Date of last search January 2002.
Methods Selection criteria: Randomised trials comparing a form of acupuncture, acupressure, laser therapy or electrostimulation with either sham treatment, another intervention or no intervention for smoking cessation. Data collection and analysis: We extracted data in duplicate on the type of smokers recruited, the nature of the acupuncture and control procedures, the outcome measures, method of randomisation, and completeness of follow-up. We assessed abstinence from smoking at the earliest time-point (before 6 weeks), at six months and at one year or more follow-up in patients smoking at baseline. We used the most rigorous definition of abstinence for each trial, and biochemically validated rates if available. Those lost to follow-up were counted as continuing to smoke. Where appropriate, we performed meta-analysis using a fixed effects model.
Main results We identified 22 studies. Acupuncture was not superior to sham acupuncture in smoking cessation at any time point. The odds ratio (OR) for early outcomes was 1.22 (95% confidence interval 0.99 to 1.49); the OR after 6 months was 1.50 (95% confidence interval 0.99 to 2.27) and after 12 months 1.08 (95% confidence interval 0.77 to 1.52). Similarly, when acupuncture was compared with other anti-smoking interventions, there were no differences in outcome at any time point. Acupuncture appeared to be superior to no intervention in the early results, but this difference was not sustained. The results with different acupuncture techniques do not show any one particular method (i.e. auricular acupuncture or non-auricular acupuncture) to be superior to control intervention. Based on the results of single studies, acupressure was found to be superior to advice; laser therapy and electrostimulation were not superior to sham forms of these therapies.
Reviewer's conclusions There is no clear evidence that acupuncture, acupressure, laser therapy or electrostimulation are effective for smoking cessation.

1.1.10. White 2000 Ø

White AR et al. Acupuncture for smoking cessation. Cochrane Database Syst Rev. 2000;2:9. [95317]

Background Acupuncture is promoted as a treatment for smoking cessation, and is believed to reduce withdrawal symptoms.
Objectives The objective of this review is to determine the effectiveness of acupuncture in smoking cessation in comparison with: a) sham acupuncture b) other interventions c) no intervention.
Methods Search strategy: We searched the Cochrane Tobacco Addiction Group trials register, Medline, PsycLit, Dissertation Abstracts, Health Planning and Administration, Social SciSearch, Smoking & Health, Embase, Biological Abstracts and DRUG. Selection criteria: Randomised trials comparing a form of acupuncture with either sham acupuncture, another intervention or no intervention for smoking cessation. Data collection and analysis: We extracted data in duplicate on the type of subjects, the nature of the acupuncture and control procedures, the outcome measures, method of randomisation, and completeness of follow-up. We assessed abstinence from smoking at the earliest time-point (before 6 weeks), at six months and at one year follow-up in patients smoking at baseline. We used the most rigorous definition of abstinence for each trial, and biochemically validated rates if available. Those lost to follow-up were counted as continuing to smoke. Where appropriate, we performed meta-analysis using a fixed effects model.
Main results We identified 18 publications involving 20 comparisons. Acupuncture was not superior to sham acupuncture in smoking cessation at any time point. The odds ratio (OR) for early outcomes was 1.22 (95% confidence interval 0.99 to 1.49); the OR after 6 months was 1.38 (95% confidence interval 0.90 to 2.11) and after 12 months 1.02 (95% confidence interval 0.72 to 1.43). Similarly, when acupuncture was compared with other anti-smoking interventions, there were no differences in outcome at any time point. Acupuncture appeared to be superior to no intervention in the early results, but this difference was not sustained. The results with different acupuncture techniques do not show any one particular method (i.e. auricular acupuncture or non-auricular acupuncture) to be superior to control intervention.
Reviewer's conclusions There is no clear evidence that acupuncture is effective for smoking cessation.

1.1.11. White 1999 Ø

White AR, Resch KL, Ernst E. A meta-analysis of acupuncture techniques for smoking cessation. Tobacco Control. 1999;8(4):393-7. [70468]

Objective To determine the effectiveness of acupuncture for smoking cessation and to examine whether any individual aspect of trials is associated with an effect.
Methods Data Sources: All randomised controlled trials of acupuncture for smoking cessation that were listed in computerised databases or reference lists of relevant articles. Study Selection: All randomised single-blind studies that compared acupuncture with sham acupuncture. Data Extraction: Methodological data were extracted for quality assessment. Outcome data were extracted for rates of total smoking cessation at three intervals: early after treatment and after six and 12 months follow up. Data Synthesis: Results were expressed as odds ratios of success over failure in intervention over control groups. The combined odds ratio for all studies was calculated. Repeated meta-analyses were subsequently performed on subsets of studies combined according to defined characteristics: acupuncture technique, number of attendances, country of origin, status of journal, and control procedure.
ResultsThe overall quality of studies was poor. The combined odds ratio for smoking cessation calculated for the earliest results after the end of treatment was 1.20 (95% confidence intervals (95% CIs) = 0.98 to 1.48). The combined odds ratio for smoking cessation after six months was 1.29 (95% CI = 0.82 to 2.01), and after 12 months was 1.03 (95% CI = 0.73 to 1.46). There were no significant effects of relevance among subsets of studies grouped according to defined characteristics.
Conclusions Acupuncture was not superior to sham acupuncture for smoking cessation; no particular aspect of acupuncture technique was associated with a positive effect. The conclusions are limited by methodological inadequacies of studies and by the absence of testable hypotheses; design of future trials should avoid these deficiencies.

1.1.12. Ashenden 1997 ☆

Ashenden R, Silagy CA, Lodge M, Fowler G. A meta analysis of the effectiveness of acupuncture in smoking cessation. Drug and Alcohol Review. 1997;16(1):33-40. [77562] The role of acupuncture in facilitating smoking cessation is controversial. A systematic review was undertaken, incorporating meta-analytic techniques, of all the available randomized controlled trials examining the effectiveness of acupuncture in smoking cessation. Based on the data from nine trials involving 2707 patients, the odds ratio of abstinence at 6-12 months' follow-up is 1.48 (95% confidence interval 1.13-1.94) with acupuncture compared to no acupuncture or sham acupuncture. The odds of quitting were higher in comparisons between acupuncture and no acupuncture (OR 2.41, CI: 1.52 to 3.83) than between acupuncture and sham acupuncture (OR 1.16, CI: 0.90 to 1.49). Many of the included trials were small and had methodological shortcomings. Therefore, while acupuncture appears promising, there is insufficient evidence at this point, without further research, to recommend it as an effective form of therapy.

1.1.13. Law 1995 Ø

Law M et al. An Analysis of the Effectiveness of Interventions intended to help People Stop Smoking. Archives of Internal Medecine. 1995;155(18):1933-41. [59883]. In a systematic review of the efficacy of interventions intended to help people stop smoking, data have been analyzed from 188 randomized controlled trials. Following persona! advice and encouragement to stop smoking given by physiciens during a single routine consultation, an estimated 2% (95% confidence limits, 1%, 3%; P<.001) of all smokers stopped smoking and did not relapse up to 1 year as a direct consequence of the advice. The effect is modest but costeffective: the cost of saving a life is about $1500. Supplementary interventions (follow-up letters or visite, demonstration of spirometry, etc) have an additional effect-variable in extent. Advice and encouragement are particularly effective for smokers at special risk-pregnant women (efficacy, 8%) and patients with ischemic heart disease. Behavior modification techniques (relaxation, rewards and punishment, avoiding “trigger” situations, etc), in group or individuel sessions led by a psychologist, have an effect that is statistically significant (P=.05) but no greater than simple advice by a physicien (2%) yet, these techniques are several times more expansive. The effect of hypnosis is unproved (no triais have used biochemical markers). Nicotine replacement therapyis effective in an estimated 13% of smokers who seek help in cessation; the effect is greater in those who are nicotine-dependent. Other pharmacological treatments are not of proven efficacy, and acupuncture is ineffective. Sudden cessation or gradual reduction in smoking are similar in their efficacy on average. Physicians should take time to advise all their patients who smoke to quit. Smokers who are intent on stopping should be given additional support and encouragea to use nicotine replacement therapy.

1.1.14. Ter Riet 1990 ∅

Ter Riet G et al. A meta-analysis of studies into the effect of acupuncture on addiction. British Journal of General Practice 1990;40(338):379-82. [83404] A literature search revealed 22 controlled clinical studies on the efficacy of acupuncture in three fields of addiction: cigarette smoking (15), heroin (five), and alcohol (two). These studies were reviewed using a list of 19 predefined criteria of good methodology. A maximum of 100 points for study design could be earned, divided over four categories: comparability of prognosis; adequate intervention; adequate effect measurement; and good data presentation. The study design was generally poor. No study earned more than 75 points and 12 studies (55%) earned less than 50 points. For smoking cessation, the number of studies with negative outcomes exceeded by far the number with positive outcomes. Taking the quality of the studies into account this negative picture becomes even stronger. For heroin and alcohol addiction controlled clinical research is both scarce and of low quality. Claims that acupuncture is efficacious as a therapy for these addictions are thus not supported by results from sound clinical research.

1.2. Special Acupuncture Techniques

1.2.1. Auricular Acupuncture

1.2.1.1. Di 2014 ☆

Di YM, May BH, Zhang AL, Zhou LW, Worsnop C, Xue CC. A meta-analysis of ear-acupuncture, ear-acupressure and auriculotherapy for cigarette smoking cessation. Drug Alcohol Depend. 2014. [179444]

Background This systematic review evaluated the effects of ear acupuncture, ear acupressure and auriculotherapy for cigarette smoking cessation (SC) at end-of-treatment (EoT), three, six and 12 months follow-up.
MethodsSearches of six English and Chinese databases located 25 randomized controlled trials (3735 participants). Methodological quality was assessed using Cochrane Risk of Bias. Meta-analyses were conducted in two pools: 1. SC-specific ear acupuncture/acupressure or auriculotherapy (EAP/R) vs. non-specific/inactive control; and 2. SC-specific EAP/R vs. other SC-specific treatment. Sensitivity analyses were conducted based on the validity of interventions as SC-specific treatments or non-specific/inactive interventions; and the use of biochemical SC confirmation.
Results Pool 1: the 12 valid SC-specific EAP/R interventions were superior to inactive EAP/R controls at EoT (RR=1.77 [1.39, 2.25]), three months follow-up (RR=1.54 [1.14, 2.08]), and six months follow-up (RR=2.01, [1.23, 3.28]) but data were insufficient at 12 months. In Pool 2: there was no superiority or inferiority for EAP/R at EoT or at 3 and 6 month follow-ups compared to SC-specific behavioural therapy or SC-specific body acupuncture.
ConclusionsPool 1 data appeared most consistent for studies of ear acupressure (EAPR) vs. non-specific EAPR controls, with confirmed SC rates at 3 months post-treatment of 20.0% for test groups vs. 7.5% for controls. In Pool 2 the EAP/R interventions appeared neither inferior nor superior to the behavioural interventions at 3 and 6 month follow-ups. However, meta-analysis results derived from relatively small-sized trials with no biochemical validation of SC in Pool 2. Larger, well-controlled studies using biochemical confirmation of SC are needed.
1.2.1.2. White 2006 ☆

White A, Moody R. The Effects of Auricular Acupuncture on Smoking Cessation may not Depend on the Point Chosen - An Exploratory Meta-Analysis. Acupunct Med. 2006;24(4):149-56. [143846].

Objectives Auricular acupuncture is given as a treatment for drug dependence. Points are usually chosen on the assumption that the body is represented somatotopically in the ear, although there is no anatomical basis for this. In clinical trials, sham treatment is often given at points that are supposedly 'incorrect' for the condition, in the belief that they are inactive. The aim of this study was to explore whether there is any difference in the effectiveness of auricular acupuncture at 'correct' and 'incorrect' points.
Methods Controlled trials of semi-permanent auricular acupuncture or acupressure for smoking cessation were systematically located, and the results combined in exploratory meta-analyses which took into account the study quality.
Results Thirteen studies were included. Combining ten studies showed auricular acupuncture at 'correct' points to be more effective than control interventions, odds ratio 2.24 (95% CI 1.61, 3.10), a result which is confirmed in the four high validity studies. Other analyses showed inconsistent results between all studies and higher quality studies. Comparisons of three higher quality studies suggest that 'correct' and 'incorrect' point acupuncture is no different (odds ratio 1.22, CI 0.72, 2.07); and two studies showed that 'incorrect' point acupuncture may be more effective than other interventions (odds ratio 1.96, CI 1.00, 3.86).
Conclusions Auricular acupuncture appears to be effective for smoking cessation, but the effect may not depend on point location. This calls into question the somatotopic model underlying auricular acupuncture and suggests a need to re-evaluate sham controlled studies which have used 'incorrect' points. Further experiments are necessary to confirm or refute these observational conclusions.

2. Clinical Practice Guidelines

⊕ positive recommendation (regardless of the level of evidence reported)
Ø negative recommendation (or lack of evidence)

2.1. US Preventive Services Task Force Recommendation Statement (USPSTF, USA) 2021 Ø

US Preventive Services Task Force, Krist AH, Davidson KW, Mangione CM, Barry MJ, Cabana M, Caughey AB, Donahue K, Doubeni CA, Epling JW Jr, Kubik M, Ogedegbe G, Pbert L, Silverstein M, Simon MA, Tseng CW, Wong JB. Interventions for Tobacco Smoking Cessation in Adults, Including Pregnant Persons: US Preventive Services Task Force Recommendation Statement. JAMA. 2021;325(3):265-79. [199746]. doi

The USPSTF considered evidence on other behavioral counseling interventions such as print-based, nontailored self-help materials, internet-based interventions, motivational interviewing, biofeedback, exercise, acupuncture, and hypnotherapy ; however, limited evidence was available on these interventions.

2.2. Réseaux de Cancerologie Rhone-Alpes (France) 2019 Ø

Sakhri L. Sevrage tabagique. Référentiels Auvergne Rhône-Alpes en Oncologie Thoracique Réseau Espace Santé-Cancer Rhône-Alpes. 2019;:25p. [195678].

La désensibilisation (vaccinothérapie), la mésothérapie, l'hypnose, l'acupuncture, l'auriculothérapie et le laser ont été évalués dans plusieurs études qui n'ont pas démontré d'efficacité de ces méthodes : on ne peut donc pas les recommander pour le sevrage tabagique.

2.3. Malaysia Health Technology Assessment Section (MaHTAS, Malysia) 2016 Ø

Malaysia Health Technology Assessment Section (MaHTAS). Treatment of Tobacco Use Disorder. Ministry of Health (MoH). 2016:102p. [172336]. URL

Hypnosis, acupuncture, acupressure, laser therapy and electrostimulation do not improve the long term abstinence rate in smoking cessation

2.4. U.S. Preventive Services Task Force (USPSTF, USA) 2015 Ø

U.S. Preventive Services Task Force. Behavioral and pharmacotherapy interventions for tobacco smoking cessation in adults, including pregnant women: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med. 2015;163(8):622-34. [188883].

Effectiveness of Interventions, Nonpregnant Adults. A 2014 review on the use of acupuncture for smoking cessation (9 studies; n = 1892) did not find increased rates of smoking cessation at 6 to 12 months.
Potential Harms of Interventions. Nonpregnant Adults. Based on the evidence reviewed by the USPSTF, only minor adverse events related to ear acupuncture, ear acupressure, and other auriculotherapy were identified. Adverse events related to other forms of behavioral interventions were not reported.

2.5. Haute Autorité de Santé (HAS, France) 2014 ∅

HAS. Arrêt de la consommation de tabac : du dépistage individuel au maintien de l’abstinence en premier recours (argumentaire scientifique). Paris: Haute Autorité de Santé (HAS). 2014. 562P. [168316].

Aucune donnée ne vient appuyer l'utilisation de l'acupuncture pour le sevrage tabagique.
4.3.2 Activité physique, acupuncture, hypnothérapie. Ces approches ont fait l’objet d’études dans l’aide à l’arrêt du tabac. Leur bénéfice dans l’aide à l’arrêt du tabac n’est pas établi, cependant, ces approches, qui bénéficient d’un certain recul, n’ont pas montré à ce jour de risque majeur. Lorsqu’un patient souhaite utiliser ces méthodes, le praticien peut le comprendre et doit avoir conscience de l’intérêt d’un éventuel effet placebo. Il doit signaler au patient que si cette prise en charge ne réussissait pas, une prise en charge dont l’efficacité a été établie pourra lui être proposée. L’éthique du médecin ne lui permet pas de recommander une thérapeutique non validée. Pour autant, le médecin ne doit pas empêcher un patient d’avoir recours à une approche qui pourrait être utile de par son effet placebo, si cette approche s’est avérée inoffensive.

2.6. Ministerio de la Salud (Argentine) 2014 Ø

Ministerio de la Salud. Guía de Práctica Clínica Nacional de Tratamiento de la Adicción al Tabaco. Buenos Aires: Ministerio de la Salud. 2014. 56p. [168738].

No se recomienda el uso de propuestas con insuficiente evidencia de efectividad: cigarrillo electrónico, glucosa, acupuntura tradicional, electroestimulación, bioinformación, biofeedback, deprivación sensorial; o evidencia de ineficacia: laser, hipnosis. Las terapias aversivas son efectivas pero se desaconseja su uso por ocasionar alta exposición al humo de tabaco.

2.7. European Society of Cardiology (ESC, Europe) 2012 Ø

European Society of Cardiology. European Guidelines on cardiovascular disease prevention in clinical practice. European Heart Journal. 2012;33:1635–1701. [196833].

There is no consistent evidence that acupuncture, acupressure, laser therapy, hypnotherapy, or electrostimulation are effective for smoking cessation.

2.8. University of Michigan Health System (UMHS, USA) 2012 Ø

Tobacco Treatment. Guidelines for Clinical Care Ambulatory. Ann Arbor: University of Michigan Health System. 2012. 16P. [168471].

There is good evidence to recommend against the use of additional modalities such as hypnosis, laser, acupuncture, and acupressure as aids to smoking cessation [A]. None of these modalities have been shown to be superior to placebo in a number of metaanalysis.

2.9. Royal Australian College of General Practitioners (Australie) 2011 Ø

Zwar N, Richmond R, Borland R, et al. Supporting smoking cessation: a guide for health professionals South Melbourne; Royal Australian College of General Practitioners. 2011; :77P. [168523].

Evidence. There is no significant effect of acupuncture or hypnotherapy in smoking Cessation (Level I) . Recommendation. On the evidence available acupuncture and hypnotherapy are not recommended as aids to smoking cessation (Strength A).

2.10. Ministerio de Salud Publica (Uruguay) 2009 Ø

Lorenzo García A, Baraibar Penco R, Melgar Alvarez S et al. Guía Nacional para el Abordaje del Tabaquismo. Montevideo: Ministerio de Salud Pública. 2009. 114P. [168720].

Existe evidencia que la acupuntura, digitopuntura, terapia láser y electroestimulación no aumentan las tasas de abstinencia a largo plazo en comparación con placebo.

2.11. National Institute for Health and Clinical Excellence (NICE, UK) 2008 Ø

National Clinical Guideline Centre. Smoking cessation services in primary care, pharmacies, local authorities and workplaces, particularly for manual working groups, pregnant women and hard to reach communities. London (UK): National Institute for Health and Clinical Excellence (NICE). 2008; :84P. [168318].

Acupuncture, acupressure, laser therapy and electro-stimulation – there is evidence that these techniques do not improve long-term abstinence rates more than a placebo.

2.12. Centro de Estudos de Medicina Baseada na Evidência (CEMBE, Portugal) 2008 Ø

Reis I, Fortuna P, Ascenção R, Costa J, Bugalho A, Vaz Carneiro A. Clinical practice guideline on smoking cessation. Lisboa: Centro de Estudos de Medicina Baseada na Evidência (CEMBE). 2008. 108P. [168426].

White et al review, exclusively based in RCTs, has shown that there is no consistent evidence that acupuncture and related techniques (digit pressure, laser therapy and electro stimulation) are effective interventions in smoking cessation, since it is not possible to prove that the effect of these techniques is a placebo effect. Nevertheless, the selected studies are heterogeneous and present several methodological flaws, thus justifying the need for further trials in order to draw firm conclusions.

2.13. Haute Autorité de Santé (HAS, France) 2007 Ø

HAS. Stratégies thérapeutiques d'aide au sevrage tabagique : efficacité, efficience et prise en charge financière. Paris: Haute Autorité de Santé (HAS). 2007. 122P. [188735].

Parmi les thérapeutiques non recommandées : Acupuncture, mésothérapie, auriculothérapie, cigarettes sans tabac, hypnose, Laser.

2.14. Ministry of Health (Nouvelle-Zélande) 2007 Ø

Ministry of Health. New Zealand smoking cessation guidelines. Wellington: Ministry of Health. 2007. 60P. [168380].

Evidence of no effectiveness. There is evidence that acupuncture, acupressure, laser therapy and electrostimulation do not improve long-term abstinence rates over that of a placebo effect.

2.15. Registered Nurses'Association of Ontario (RNAO, Canada) 2007 Ø

Association des infirmières et infirmiers autorisés de l'Ontario. La cessation du tabagisme : intégration dans la pratique quotidienne des soins infirmiers. Lignes directrices sur les pratiques exemplaires en soins infirmiers. Toronto: RNAO; 2007.[169597].

Bien que l’acupuncture et l’hypnothérapie soient répandues, il n’existe pas suffisamment de données probantes pour établir leur efficacité (Joanna Briggs Institute, 2001). Toutefois, si une personne croit que ces méthodes sont efficaces, une consultation en acupuncture ou en hypnothérapie peut être bénéfique (U.S. Dept. of Health and Human Services, 2000; University of Toronto, 2000).

2.16. Dutch Institute for Health Care CBO (Pays-Bas) 2006 Ø

Dutch Institute for Health Care CBO. Guideline treatment of tobacco dependence. Den Haag: Dutch Institute for Health Care CBO. 2006. 170P. [168460].

There are no indications that alternative therapies (hypnosis, acupuncture) work better than placebo (level 3).

2.17. Ministerio de Salud y Ambiente de la Nación (Argentine) 2005 Ø

Ministerio de Salud y Ambiente de la Nación. Guía nacional de tratamiento de la adicción al tabaco. Buenos Aires: Ministerio de Salud y Ambiente de la Nación. 2005; : 23P. [168633].

No se recomienda el uso de tratamientos sobre los cuales existe insuficiente evidencia que avale su utilización (láser, electroestimulación, mecamilamina, naltrexona, lobelina, acetato de plata, terapias aversivas, ansiolíticos, y acupuntura) o cuando existe evidencia que confirma su ineficacia (hipnoterapia y antidepresivos inhibidores de la recaptación de serotonina).

2.18. Haute Autorité de Santé (HAS, France) 2004 Ø

HAS. Recommandation de bonne pratique : Grossesse et tabac. Paris: Haute Autorité de Santé (HAS). 2004. 37P. [188736].

Les résultats sur l’efficacité de l’acupuncture dans la population générale sont contradictoires selon les études : un effet spécifique, différent de l’effet placebo, n’est pas clairement démontré. Il n’y a pas d’études spécifiques à la femme enceinte pour l’hypnothérapie et l’acupuncture, ni d’accord professionnel pour les recommander.

2.19. Centre fédéral d'expertise des soins de santé (KCE, Belgique) 2004 Ø

Van den Bruel,A, Cleemput,I, Schoefs,D, Ramaekers,D, Bonneux,L. Efficacité et rentabilité des thérapies du sevrage tabagique. Bruxelles:Centre fédéral d'expertise des soins de santé (KCE). 2004. 136P. [167473].

Aucune donnée ne vient appuyer l’intérêt de l’acupuncture pour le sevrage tabagique. Aucune donnée ne prouve l'effet de l'acupuncture sur le sevrage tabagique, mais les études sont restreintes et les intervalles de confiance sont larges.

2.20. Agence Française de Sécurité Sanitaire des Produits de Santé (AFSSAPS, France) 2003 Ø

AFSSAPS. Les stratégies thérapeutiques médicamenteuses et non médicamenteuses de l'aide a l'arrêt du tabac. Recommandations. Agence Française de Sécurité Sanitaire des Produits de Santé. 2003. 39p. [131624]

Thérapeutiques non recommandées - l’acupuncture, la mésothérapie, l’auriculothérapie, les cigarettes sans tabac, l’hypnose, le laser.

2.21. U.S. Department of Health and Human Services (USA) 2000 Ø

Fiore MC, Bailey WC, Stuart J. Cohen SJ, Dorfman SF, Goldstein MG. Treating Tobacco Use and Dependence. U.S. Department of Health and Human Services. 2000. 196P. [160710].

Acupuncture. A separate meta-analysis was conducted for acupuncture. This analysis was conducted to achieve a sensitive test on the small body of studies that use this technique. Evidence, as shown in Table 24, did not support the efficacy of acupuncture as a smoking cessation treatment. The acupuncture meta-analysis comparing “active” acupuncture with “control” acupuncture revealed no difference in efficacy between the two types of procedures. These results suggest that any effect of acupuncture might be produced by factors such as positive expectations about the procedure.

2.22. Agence Nationale d'Accréditation et d'Evaluation en Santé (ANAES, France) 1998 Ø

ANAES. Conférence de consensus Arrêt de la consommation du tabac 8 et 9 octobre 1998. Paris: Agence Nationale d'Accréditation et d'Evaluation en Santé. 1998. 26P. [172652].

Autres méthodes : acupuncture, homéopathie, mésothérapie, hypnose. L'acupuncture et l'homéopathie ont été évaluées mais la faible qualité méthodologique de nombreux essais et les résultats contradictoires ne permettent pas d'en tirer des conclusions fiables. Pour ces quatre méthodes, il est particulièrement difficile de dissocier le rôle de l'empathie délivrée au patient de l'effet spécifique propre à chaque méthode. De nouvelles évaluations d'efficacité conduites selon les critères spécifiques habituels et prenant en compte les divers facteurs en cause paraissent souhaitables.

3. Overviews of Clinical Practice Guidelines

3.1. Verbiest 2017

  • Verbiest M, Brakema E, van der Kleij R, Sheals K, Allistone G, Williams S, McEwen A, Chavannes N.Lignes directrices nationales pour l'abandon du tabac dans les soins primaires : une revue de la littérature et une analyse des preuves. NPJ Prim Care Respir Med . 2017 20 janvier 27 (1): 2. [001]
Objectifs National guidelines for smoking cessation in primary care can be effective in improving clinical practice. This study assessed which parties are involved in the development of such guidelines worldwide, which national guidelines address primary care, what recommendations are made for primary care settings, and how these recommendations correlate with each other and with current evidence.
Méthodes We identified national guidelines using an online resource. Only the most recent version of a guideline was included. If an English version was not available, we requested a translation or summary of the recommendations from the authors. Two researchers independently extracted data on funding sources, development methodologies, involved parties, and recommendations made within the guidelines. These recommendations were categorised using the pile-sort method. Each recommendation was cross-checked with the latest evidence and was awarded an evidence-rating.
Résultats We identified 43 guidelines from 39 countries and after exclusion, we analysed 26 guidelines (22 targeting general population, 4 targeted subpopulations). Twelve categories of recommendations for primary care were identified. There was almost universal agreement regarding the need to identify smokers, advice them to quit and offer behavioural and pharmacological quit smoking support. Discrepancies were greatest for specific recommendations regarding behavioural and pharmacological support, which are likely to be due to different interpretations of evidence and/or differences in contextual health environments.
Conclusions Based on these findings, we developed a universal checklist of guideline recommendations as a practice tool for primary care professionals and future guideline developers.
Acupuncture Hypnotherapy and acupuncture are not effective smoking cessation treatments (6 recommendations/22).

3.2. Astrid Becerra 2012

Astrid Becerra N, Alba LH, Castillo JS, Murillo R, Cañas A, García-Herreros P. [Alternative therapies for smoking cessation: clinical practice guidelines review]. Gac Med Mex. 2012;148(5):457-66. [166433].

BackgroundSmoking is a chronic disease in the group of addictions and its treatment includes two components:psychosocial and pharmacological intervention. Other types of therapeutic approaches have been used as treatment options for tobacco addiction. Acupuncture, hypnosis and homeopathy are the most used nonconventional interventions.
ObjectiveReview the available evidence in regards to the use of alternative therapies for smoking cessation in the adult population from the published clinical practice guidelines (CPG).
MethodsWe performed an adaptation process of clinical recommendations from a systematic review of the literature specifically related to the use of alternative therapies for smoking cessation.
ResultsWe found 925 references, 9 were pre-screened and selected 5 CPG for adaptation.Acupuncture and related techniques do not improve abstinence rates compared to the placebo effect. There is insufficient evidence to recommend the use of hypnosis as a therapy for smoking cessation. There is no evidence that justifies the use of homeopathic medicines for the treatment of smoking.
ConclusionsAlternative therapies have not demonstrated efficacy in cessation. It is recommended to use other treatment options with proven efficacy for smoking cessation.