Topiramate for smoking cessation: Systematic review and meta-analysis
Nesma Lotfy 1  
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High Institute of Public Health, Alexandria University, Alexandria, Egypt
Nesma Lotfy   

High Institute of Public Health, Alexandria University, 165 El-Horeya Road, Alexandria Governorate, Egypt
Publication date: 2020-02-24
Submission date: 2019-09-21
Final revision date: 2019-12-04
Acceptance date: 2019-12-09
Tob. Prev. Cessation 2020;6(February):14
Topiramate is an antiepileptic drug that has been used for many labeled and off-labeled indications. It may be useful in reducing withdrawal symptoms of various addictive agents such as alcohol, cocaine, cannabis and smoking. To date, some studies have examined the effectiveness of topiramate for smoking cessation. The present review aims to synthesize the results from those studies and determine topiramate effectiveness in smoking cessation.

A comprehensive search was conducted in the databases: PubMed/ Medline, Cochrane, Egyptian Knowledge Bank, and Google Scholar. All clinical trials that examined the effect of topiramate, compared with the placebo, on smoking cessation rate were included. Statistical analysis using fixed effect models, heterogeneity and sensitivity analysis were conducted using RevMan 5.3.

Five trials met the inclusion criteria and were included in the metaanalysis. Topiramate non-significantly increased prolonged smoking abstinence rate (OR=1.19, 95% CI: 0.57–2.5) compared with the placebo. On the other hand, topiramate significantly increased the abstinence rate at weeks 4, 6, 8 and 12 (OR=3.07, 95% CI: 1.19–7.93; OR=4.03, 95% CI: 1.98–8.2; OR=2.29, 95% CI: 1.23–4.28; and OR=2.45, 95% CI: 1.37–4.39; respectively) compared with the placebo.

Based on the five trials, where publication bias cannot be excluded, the current evidence is not sufficient to show a significant difference to favor topiramate in prolonged smoking cessation over the placebo, although the 12th week point prevalence favored topiramate.

The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none was reported.
There was no source of funding for this research.
Search idea: HE. Search strategy and selection criteria: HE and NL. Risk of bias assessment: HE and NL. Meta-analysis: HE and NL. All time-points meta-analysis (ATM) : NL. Writing up of original draft: HE and NL. Review: MH. Writing the final manuscript: NL.
Not commissioned; externally peer reviewed.
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