Acupuncture for smoking cessation: A systematic review and meta-analysis of 24 randomized controlled trials
Jian-Hua Wang 1, 2
Mei Wang 4
Guan-Lin Yang 1
Zhe Zhang 5
Li-Qiong Wang 2
Ya-Qiang Zhou 5
Mei Yin 1
Cheng-Yu Xiao 5
A-Li Duan 1
Shu-Chun Liu 6
Bin Chen 6
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Science and Technology Department, Liaoning University of Traditional Chinese Medicine, Shenyang, China
Centre for Evidence- Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
International Institute for Integrative Medicine, Kingston, United Kingdom
School of Preclinical Medicine, Liaoning University of Traditional Chinese Medicine, Shenyang, China
Affiliated Hospital, Liaoning University of Traditional Chinese Medicine, Shenyang, China
Medical Library, Liaoning University of Traditional Chinese Medicine, Shenyang, China
Jian-Ping Liu   

Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, 11 Bei San Huan Dong Lu, Chaoyang District, Beijing 100029, China
Publish date: 2019-06-04
Tob. Induc. Dis. 2019;17(June):48
We evaluate the effectiveness and safety of transdermal acupuncture by needles for smoking cessation.

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 Beta software.

Twenty-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% CI: 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% CI: 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.

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.

RCT: randomized controlled trial, NRT: nicotine replacement therapy, NWS: nicotine withdrawal symptoms, FTND: Fagerström test for nicotine dependence; BDI: Beck Depression Inventory, BAI: Beck Anxiety Inventory, CO: exhaled carbon monoxide; HIS: Heaviness of Smoking Index, QSU-Brief: brief questionnaire of smoking urges, CI: confidence intervals, MD: mean difference, RD: risk difference, RR: risk ratio, REM: random effects model, FEM: fixed effects model, TCM: Traditional Chinese Medicine, TSA: trial sequential analysis, RIS: required information size
Authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none was reported.
This work was supported by the Youth Project of Humanities and Social Science Research of Department of Education in Liaoning Province (L201731) and the Youth Research of Economic and Social Development of Liaoning Provincial Federation Social Science Circles (2017lslktqn-085). J.P. Liu was partially supported by a grant (R24 AT001293) from the USA National Center for Complementary and Alternative Medicine. The funders had no role in study design, data collection and analysis, writing the manuscript, decision to publish, or preparation of the manuscript.
J.P.L. and R.v.H. conceived and designed the study. J.H.W. conducted study search and identification with S.C.L., B.C., M.W., M.Y. and A.L.D., and conducted inclusion/exclusion, study selection, data extraction, quality assessment with G.L.Y., Z.Z. and C.Y.X. J.H.W., L.Q.W. and Y.Q.Z. contributed to data analysis. J.H.W. wrote the first draft of the manuscript. J.P.L., R.v.H., M.E.F. and J.H.W. participated in the revision of a subsequent draft.
Not commissioned; externally peer reviewed.
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