Systematic Review and Meta-Analysis of the Efficacy and Tolerability of Nicotine Preparations in Active Ulcerative Colitis

BackgroundFindings from clinical studies of the efficacy and tolerability of nicotine preparations in maintaining remission of ulcerative colitis (UC) have been inconsistent.ObjectivesThis systematic review and meta-analysis aimed to assess the efficacy and tolerability of nicotine preparations in inducing remission in UC.MethodsA literature search (1966August 2010) of Scopus (EMBASE), PubMed, Web of Science, and the Cochrane Central Register of Controlled Trials was conducted for clinical trials that investigated the efficacy and/or tolerability (any adverse events [AEs] and withdrawals due to AEs) of any nicotine preparation for the induction of remission in UC.ResultsThe electronic searches yielded 788 items. Of these, 3 placebo-controlled trials representing 233 patients with UC and 2 randomized controlled trials that compared nicotine to corticosteroids in 81 patients with UC were included in meta-analysis. The summary relative risks (RRs) (95% CI) in comparing nicotine to placebo were 1.40 (0.63–3.12) (P = NS) for clinical remission, 1.95 (1.38–2.78) (P < 0.001) for AEs, and 3.44 (0.71–16.71) (P = NS) for withdrawal due to AEs. The summary RRs in comparing nicotine to corticosteroids (prednisolone/prednisone) were 0.74 (0.5–1.09) (P = NS) for clinical remission in 2 trials and 2.28 (0.76–6.83) (P = NS) for withdrawal due to AEs.ConclusionThe findings from this meta-analysis do not support the efficacy or tolerability of nicotine preparations in inducing remission in UC.