Evidence of nicotine replacement's effectiveness dissolves when meta-regression accommodates multiple sources of bias

T. D. Stanley, Shelby Massey

    Research output: Contribution to journalArticle

    12 Citations (Scopus)

    Abstract

    Objectives To accommodate and correct identifiable bias and risks of bias among clinical trials of nicotine replacement therapy (NRT). Study Design and Setting Meta-regression analysis of a published Cochrane Collaboration systematic review of 122 placebo-controlled clinical trials. Results Both identified risks of bias and potential publication (or reporting or small sample) bias are associated with an increase in the reported effectiveness of NRT. Whenever multiple sources of biases are accommodated by meta-regression, no evidence of a practically notable or statistically significant overall increased rate of smoking cessation remains. Our findings are in stark contrast with the 50% to 70% increase in smoking cessation reported by the Cochrane Collaboration systematic review. Conclusion After more than 100 randomized clinical trials have been conducted, the overall effectiveness of NRT is in doubt. Simple, well-established meta-regression methods can test, accommodate, and correct multiple sources biases, often mentioned but dismissed by conventional systematic reviews.

    Original languageEnglish
    Pages (from-to)41-45
    Number of pages5
    JournalJournal of Clinical Epidemiology
    Volume79
    DOIs
    StatePublished - 1 Nov 2016

    Fingerprint

    Nicotine
    Smoking Cessation
    Publication Bias
    Controlled Clinical Trials
    Meta-Analysis
    Therapeutics
    Randomized Controlled Trials
    Placebos
    Regression Analysis
    Clinical Trials

    Keywords

    • Egger regression
    • Meta-regression
    • Nicotine replacement therapy
    • Precision-effect test
    • Publication bias
    • Risks of bias

    Cite this

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    abstract = "Objectives To accommodate and correct identifiable bias and risks of bias among clinical trials of nicotine replacement therapy (NRT). Study Design and Setting Meta-regression analysis of a published Cochrane Collaboration systematic review of 122 placebo-controlled clinical trials. Results Both identified risks of bias and potential publication (or reporting or small sample) bias are associated with an increase in the reported effectiveness of NRT. Whenever multiple sources of biases are accommodated by meta-regression, no evidence of a practically notable or statistically significant overall increased rate of smoking cessation remains. Our findings are in stark contrast with the 50{\%} to 70{\%} increase in smoking cessation reported by the Cochrane Collaboration systematic review. Conclusion After more than 100 randomized clinical trials have been conducted, the overall effectiveness of NRT is in doubt. Simple, well-established meta-regression methods can test, accommodate, and correct multiple sources biases, often mentioned but dismissed by conventional systematic reviews.",
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    N2 - Objectives To accommodate and correct identifiable bias and risks of bias among clinical trials of nicotine replacement therapy (NRT). Study Design and Setting Meta-regression analysis of a published Cochrane Collaboration systematic review of 122 placebo-controlled clinical trials. Results Both identified risks of bias and potential publication (or reporting or small sample) bias are associated with an increase in the reported effectiveness of NRT. Whenever multiple sources of biases are accommodated by meta-regression, no evidence of a practically notable or statistically significant overall increased rate of smoking cessation remains. Our findings are in stark contrast with the 50% to 70% increase in smoking cessation reported by the Cochrane Collaboration systematic review. Conclusion After more than 100 randomized clinical trials have been conducted, the overall effectiveness of NRT is in doubt. Simple, well-established meta-regression methods can test, accommodate, and correct multiple sources biases, often mentioned but dismissed by conventional systematic reviews.

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    KW - Precision-effect test

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    KW - Risks of bias

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