Les Newsletters de Stop-Tabac.ch
15 janvier 2008
| Nouvelles sur le tabagisme de Stop-tabac.ch
Préparées par Jean-François Etter
Le 15 Janvier 2008
- Les cigarettes NTB (sans tabac) sont elles autorisées en Suisse?
- Si vous êtes âgé de 15 à 20 ans
- Cannabinoid type 1 receptor antagonists (rimonabant) for smoking cessation
La vente des produits à la base des succédanés du tabac NTB est en Suisse explicitement autorisée par l'OFSP.
L'OFSP a accordé une telle autorisation 14 octobre 2004 et l'a renouvelée le 26 octobre 2006. Cela a été publiée dans le Feuille officielle suisse du commerce :
Les conditions légales pour ces produits sont en Suisse très similaires aux conditions requises pour les cigarettes de tabac. Aucune indication sur les effets favorables pour la santé n'est autorisée et à l'exception sur celle qui concerne la dépendance toutes les mises en gardes sont aussi obligatoires.
Voir les articles 3 et 4 de l'OTab sous :
Si vous êtes âgé de 15 à 20 ans, donnez-nous votre avis sur un site préparé par nos étudiants, sur les risques lors des soirées.
Plus de 20 ans s'abstenir.
Life Night: gère ta soirée ! Cliquez ici:
Cochrane Database Syst Rev. 2007 Jul 18;(3):CD005353.
Cahill K, Ussher M.
BACKGROUND: Rimonabant is a selective type 1 cannabinoid (CB1) receptor antagonist. It may assist with smoking cessation by restoring the balance of the endocannabinoid system, which can be disrupted by prolonged use of nicotine. Rimonabant also seeks to address many smokers' reluctance to persist with a quit attempt because of concerns about weight gain.
OBJECTIVES: To determine whether selective CB1 receptor antagonists increase the numbers of people stopping smoking To assess their effects on weight change in successful quitters and in those who try to quit but fail.
SEARCH STRATEGY: We searched the Cochrane Tobacco Addiction Review Group specialized register for trials, using the terms 'rimonabant' and 'smoking' in the title or abstract, or as keywords. We also searched MEDLIN! E, EMBASE, CINAHL and PsycINFO, using major MESH terms. We acquired electronic or paper copies of posters of preliminary trial results presented at the American Thoracic Society Meeting in 2005, and at the Society for Research on Nicotine and Tobacco European Meeting 2006. We also attempted to contact the authors of ongoing studies of rimonabant, and Sanofi Aventis (manufacturers of rimonabant).
SELECTION CRITERIA: Types of studiesRandomized controlled trialsTypes of participantsAdult smokersTypes of interventionsSelective CB1 receptor antagonists, such as rimonabant.Types of outcome measuresThe primary outcome is smoking status at a minimum of six months after the start of treatment. We preferred sustained cessation rates to point prevalence, and biochemically verified cessation to self-reported quitting. We regarded smokers who drop out or are lost to follow up as continuing smokers. We have noted any adverse effects of treatment.A secondary outcome is weight change a! ssociated with the cessation attempt.
DATA COLLECTION AND ! ANALYSIS : Two authors checked the abstracts for relevance, and attempted to acquire full trial reports. One author extracted the data, and a second author checked them.
MAIN RESULTS: We found three trials which met our inclusion criteria, covering 1567 smokers (cessation: STRATUS-EU and STRATUS-US), and 1661 quitters (relapse prevention: STRATUS-WW). At one year, the pooled odds ratio (OR) for quitting with rimonabant 20 mg was 1.61 (95% confidence interval (CI) 1.12 to 2.30). No significant benefit was demonstrated for rimonabant at 5 mg dosage. Adverse events included nausea and upper respiratory tract infections.In the relapse prevention trial, smokers who had quit on the 20 mg regimen were 1(1/2) times more likely to remain abstinent on either active regimen than on placebo; the OR for the 20 mg maintenance group was 1.49 (95% CI 1.09 to 2.04, and for the 5 mg maintenance group 1.51 (95% CI 1.11 to 2.07). There appeared to be no significant benefit of maintenance treatment f! or the 5 mg quitters.Weight gain was reported to be significantly lower among the 20 mg quitters than in the 5 mg or placebo quitters. During treatment, overweight or obese smokers tended to lose weight, while normal weight smokers did not.
AUTHORS' CONCLUSIONS: From the preliminary trial reports available, rimonabant 20 mg may increase the odds of quitting approximately 1(1/2)-fold. Adverse events include nausea and upper respiratory tract infections; the risk of serious adverse events is reported to be low. The evidence for rimonabant in maintaining abstinence is inconclusive. Rimonabant 20 mg may moderate weight gain in the long term.
Plain language summary
Rimonabant is a selective CB1 receptor antagonist which may help smokers to quit, and may also reduce the amount of weight gained during the quitting process
Long-term use of nicotine can upset the endocannabinoid system in the brain, which controls food intake and energy balance. Rimonaban! t may help smokers to quit by rebalancing the system, which th! en reduc es nicotine and food cravings. We searched our own specialised register of controlled trials. We also contacted Sanofi-Aventis, the manufacturers of rimonabant, and researchers who presented early findings at conferences. We found two randomized controlled trials (RCTs) of rimonabant for smoking cessation, covering 1567 smokers, and one RCT of rimonabant for relapse prevention covering 1661 quitters. Although full trial reports are not yet published, our own analyses show that rimonabant at the 20 mg dose increased by 1-fold the odds of not smoking at one year, compared with placebo. Rimonabant 5 mg did no better than placebo at any time point. In the relapse prevention trial, smokers who quit successfully on rimonabant 20 mg were 1 times more likely to remain abstinent on active treatment (5 mg or 20 mg) than on placebo. For those who quit successfully on 5 mg, neither active nor placebo treatment appeared to benefit them in avoiding relapse. This inconsistent picture makes! it difficult to find a clear benefit for rimonabant in preventing relapse. Although the evidence on weight change is sparse in these trials, weight gain was reported to be significantly lower among the 20 mg quitters than in the 5 mg or placebo quitters. During treatment, overweight or obese smokers tended to lose weight on 20 mg, while normal weight smokers did not. Main side effects were nausea and upper respiratory tract infections, and serious harms were reported to be low.