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

Abstract: Background: Findings from clinical studies of the efficacy and tolerability of nicotine preparations in maintaining remission of ulcerative colitis (UC) have been inconsistent. Objectives: This systematic review and meta-analysis aimed to assess the efficacy and tolerability of nicotine preparations in inducing remission in UC. Methods: A 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. Results: The 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. Conclusion: The findings from this meta-analysis do not support the efficacy or tolerability of nicotine preparations in inducing remission in UC.