For Smokers With Schizophrenia, Varenicline Found Most Effective at Achieving Abstinence

Smokers with schizophrenia who received pharmacotherapeutic smoking cessation aids, especially the medication varenicline, had significantly higher abstinence rates compared with smokers with schizophrenia who received a placebo, according to a study published in Psychiatric Services.

“Despite evidence of the safety and efficacy of first-line pharmacotherapeutic cessation aids in this population, clinicians report negative attitudes toward providing smoking cessation treatment for smokers with schizophrenia, and pharmacotherapy—particularly non-nicotine pharmacotherapy—is particularly underutilized,” wrote A. Eden Evins, M.D., M.P.H., of Massachusetts General Hospital and colleagues.

Evins and colleagues analyzed data on abstinence rates and neuropsychiatric adverse events (NPSAEs) that were collected as part of the Evaluating Adverse Events in a Global Smoking Cessation Study (EAGLES). EAGLES was conducted from November 2011 to January 2015 with participants aged 18 to 75 who smoked 10 or more cigarettes a day. There were 390 participants with schizophrenia spectrum disorders (including schizophrenia and schizoaffective disorders) and 4,028 without a psychiatric illness (the control group).

Participants were randomly assigned to receive 1 mg varenicline twice daily, 150 mg buproprion sustained-release twice daily, 21 mg of a nicotine replacement therapy patch daily, or a placebo for 12 weeks. Participants set a quit date for one week after random assignment, and study visits occurred weekly for six weeks, biweekly for six weeks, and then at weeks 13, 16, 20, and 24. Participants also received 10 minutes of smoking cessation counseling at each visit.

During each study visit, smokers with schizophrenia who were assigned to varenicline had significantly higher rates of abstinence (defined as self-reported tobacco abstinence since the previous study visit) compared with the placebo group. Participants receiving buproprion and nicotine replacement therapy also had higher rates of abstinence than the participants in the placebo group, though the rates were not as high as those for the group receiving varenicline. The participants without a psychiatric disorder overall had higher rates of abstinence, with varenicline also associated with the highest rates.

Neuropsychiatric adverse events were not significantly higher for smokers with schizophrenia receiving any active treatment compared with the placebo group. The estimated rate of neuropsychiatric adverse events was 5% for participants with schizophrenia and 1% for participants without a psychiatric disorder.

“Tobacco smokers, particularly smokers with schizophrenia, need help to quit,” the authors concluded. “These data, together with strong evidence that smoking cessation does not exacerbate mental illness and strong consistent evidence for low abstinence rates among smokers with schizophrenia with behavioral treatment alone,” support greater use of smoking cessation aids for smokers with schizophrenia as a standard of care.

For related information, see the Psychiatric News article “Schizophrenia Patients Show Cognitive Improvements After Smoking Cessation.”

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