Systematic review of Swedish snus for smoking cessation based on primary subject data from randomised clinical trials

• Published in: Journal of smoking cessation Vol. 8; no. 1; pp. 33 - 44
• Main Authors: Rutqvist, L. E., Fry, J. S., Lee, P. N.
• Format: Journal Article
• Language: English
• Published: Cambridge, UK Cambridge University Press 01.06.2013
• Subjects: Behavior modification; Clinical trials; Evaluation; Meta-analysis; Physiological effect; Smoke; Smoking cessation; Systematic review; Tobacco; Sweden; Systematic review; randomised trial; Swedish snus; smoking cessation
• ISSN: 1834-2612; 1834-2612
• DOI: 10.1017/jsc.2013.10

Introduction: The ability of Swedish snus to serve as a smoking cessation aid has been documented in several observational, population surveys from Scandinavia, but randomised clinical trials provide more reliable information on efficacy. Aims: To perform a systematic review and meta-analysis of randomised clinical trials of Swedish snus as an aid to smoking cessation. Methods: Literature searches were conducted in MedLine, Cochrane Library, and Embase to identify relevant clinical trials. The primary outcome was defined as biologically confirmed smoking cessation during around six months. Meta-analyses based on primary subject data tested for effect of allocated treatment as well as selected baseline characteristics. Results: There were two relevant clinical trials, one conducted at five sites in the US (n = 250), the other at two sites in Serbia (n = 319). Based on the primary outcome, success was higher in the treated group in both Serbia (5.7% vs 1.9%) and the US (4.0% vs 1.6%). Meta-analysis estimated the relative success rate at 2.83 (95% CI 1.03–7.75), which was of borderline significance (exact p = 0.06, chi-squared p = 0.03). For smoking cessation in the last 4 weeks of each study, rates were 12.4% for snus and 6.6% for placebo (RR 1.86, 95% CI 1.09-3.18). Efficacy of snus was not clearly related to any baseline characteristic. Conclusions: Swedish snus increased quit rates similarly in US and Serbia. These results confirm and extend previous information based on observational population surveys.