The Efficacy Of Nicotine In The Patients With Active Ulcerative Colitis: A Meta-analysis

Objective: To assess the efficacy and safety of nicotine in the treatment of ulcerativecolitis(UC).Methods: According the retrieval strategy, the inclusion criteria and the exclusioncriteria of this meta-analysis, all clinical study articles in English or in Chinese aboutnicotine for UC were searched by PubMed(Medline)，OVID，the Cochrane Library，Wanfang Database，VIP，CNKI and Google Scholar. The methodologic quality of theincluded trials was evaluated using the Jadad score. And then the efficacy and safetyof any nicotine preparation for the induction of remission in UC patients wereinvestigated and the OR values and its95％CI were calculated by the softwareRevMan5.2.Results: Ninety-nine articles were searched and6RCT articles met the criteria wereselected for this meta-analysis. The analysis showed that either transdermal nicotineor nicotine enema had not superior to the standard medical therapy(oral prednisone ormesalamine) for patients with mild to moderate activity of UC(OR=0.90，95%CI：0.12-6.94). The adverse events(OR=3.04，95%CI：1.94-4.78)and the withdrawalnumbers due to them(OR=4.40，95%CI：1.35-14.40) in patients with nicotine werelikely more than those in patients treated with placebo or standard medical therapy.However，the meta-analysis of2RCTs included66patients treated with transdermalnicotine and70patients treated with a placebo demonstrated the significant benefit ofthe transdermal nicotine therapy(OR=3.19，95%CI：1.24-8.22).Conclusions: This meta-analysis provides an evidence that transdermal nicotine issuperior to placebo, but not to standard medical therapy (oral prednisone ormesalamine) for the induction of remission in patient’s with mild to moderate activityof UC. Adverse events associated with nicotine are significant and limit its use in theclinic.