Effectiveness of areca nut and products containing areca nut cessation interventions: A network meta-analysis

Abstract

Introduction: Areca nut (AN) is the fourth commonly used psychoactive substance, some using it with tobacco (processed AN with tobacco [PANT]). AN–PANT predisposes to a myriad of health disorders. AN–PANT cessation strategies are modeled after tobacco cessation programs, and their efficacies are not evaluated critically. The present study aimed to assess the relative effectiveness of different AN–PANT cessation interventions using a nonparametric network meta-analysis (NMA). Material and Method: An NMA was conducted after registration with Prospero. A systematic search across PubMed, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) databases yielded 137 articles, with 29 duplicates removed. The study population, interventions, comparators, and outcomes framework guided selection criteria for ensuring a robust and relevant analysis. Result: In all, 11 interventions were evaluated across 9 studies involving 12,659 patients. The effect of cessation intervention, as an odds ratio with 95% credibility limits, ranged from 0.30 (0.022–4.01) for a type of behavioral intervention to 10.5 (0.62–229) for Escitalopram. The odds ratio of 95% credible interval of a few studies was only crossing 1. The risk of bias assessment demonstrated the extent of biases within the included trials, contributing to a comprehensive understanding of the wholesome evidence as of the end of 2023. Discussion: The present study underscores the urgent need to re-evaluate the study designs employed in AN/PANT addiction-cessation trials. The present evidence-based insights provided by this NMA could serve as a foundation for designing future trials and guiding clinical decision-making and policy development.

Keywords

• betel nut
• areca nut
• orphan addiction
• betel quid
• south east asia