Acupuncture and related acupoint therapies for smoking cessation: An umbrella review and updated meta-analysis

Ying-Ying Zhang; You-Zhu Su; Zi-Yu Tian; Shi-Bing Liang; Yi-Jie Liu; Yu-Fei Li; Hai-Fa Qiao; Nicola Robinson; Jian-Ping Liu

doi:10.18332/tid/186147

Acupuncture and related acupoint therapies for smoking cessation: An umbrella review and updated meta-analysis

Tob Induc Dis. 2024 Apr 18:22. doi: 10.18332/tid/186147. eCollection 2024.

Authors

Ying-Ying Zhang^{1

2

3}, You-Zhu Su³, Zi-Yu Tian⁴, Shi-Bing Liang⁵, Yi-Jie Liu¹, Yu-Fei Li³, Hai-Fa Qiao^{1

2}, Nicola Robinson^{3

6}, Jian-Ping Liu³

Affiliations

¹ College of Acupuncture-Moxibustion and Tuina, Shaanxi University of Chinese Medicine, Xianyang, China.
² Key Laboratory of Acupuncture and Medicine in Shaanxi Province, Xianyang, China.
³ Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China.
⁴ Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China.
⁵ Clinical Study Center, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China.
⁶ Institute of Health and Social Care, London South Bank University, London, United Kingdom.

Abstract

Introduction: Acupuncture and related acupoint therapies have been widely used for smoking cessation. Some relevant systematic reviews (SRs) have been published. There is a need to summarize and update the evidence to inform practice and decision-making.

Methods: Eight databases were searched from their inception to December 2023. SRs, any randomized controlled trials (RCTs) comparing acupuncture therapies with sham acupuncture, pharmacotherapy, behavioral therapy, or no treatment, were included. The primary outcome was the abstinence rate. AMSTAR-2 was employed to assess the quality of SRs. An updated meta-analysis was conducted based on SRs and RCTs. Data were synthesized using risk ratios (RR) with 95% confidence intervals (CIs). The GRADE approach was employed to assess the certainty of the updated evidence.

Results: Thirteen SRs and 20 RCTs outside of the SRs were identified. The SRs were of low or very low quality by AMSTAR-2. Sixteen (80%) RCTs were at high risk of performance bias. Eight acupuncture and related acupoint therapies were involved. The short-term (≤6 months) abstinence rate outcome was summarized as follows. Most SRs suggested that filiform needle acupuncture or acupressure had a better effect than sham acupuncture, but the findings were inconsistent. The updated meta-analysis also suggested that filiform needle acupuncture was more effective than sham acupuncture (RR=1.44; 95% CI: 1.02-2.02; I² = 66%; low certainty; 9 RCTs, n=1358). Filiform needle acupuncture combined with acupressure was comparable to nicotine patches (RR=0.99; 95% CI: 0.74-1.32; low certainty; 6 RCTs, n= 524). Acupressure was superior to counseling (RR=1.46; 95% CI: 1.14-1.87; I²=5%; low certainty; 8 RCTs, n=595). No serious adverse events were reported in these SRs or RCTs.

Conclusions: Low certainty evidence suggests that filiform needle acupuncture and auricular acupressure appear to be safe and effective in achieving short-term smoking cessation. However, long-term follow-up data are needed.

Keywords: acupressure; acupuncture; meta-analysis; smoking cessation; umbrella review.

Publication types

Review

Grants and funding

FUNDING This work was supported by the Youth project of the National Natural Science Foundation of China (No.82305395); the key laboratory project of Shaanxi Provincial Department of Education (No.23JS014); and Key research and development plan of Science and Technology Department of Shaanxi Province (No.2024SF-YBXM-089). The funders had no role in study design, data collection and analysis, drafting the manuscript, decision to publish, or preparation of the manuscript.