Acupuncture for smoking cessation: A systematic review and meta-analysis of 24 randomized controlled trials

INTRODUCTION We 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 I-2>75%). Trial sequential analysis (TSA) was applied by TSA 0.9.5.10 Beta software. RESULTS 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. 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.