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Randomized Controlled Trial
. 2017 May:183:124-129.
doi: 10.1016/j.schres.2016.11.018. Epub 2016 Dec 9.

Maintenance pharmacotherapy normalizes the relapse curve in recently abstinent tobacco smokers with schizophrenia and bipolar disorder

A Eden Evins  1 , Susanne S Hoeppner  2 , David A Schoenfeld  3 , Bettina B Hoeppner  2 , Corinne Cather  2 , Gladys N Pachas  2 , Kristina M Cieslak  2 , Melissa Culhane Maravic  2
Affiliations
Randomized Controlled Trial

Maintenance pharmacotherapy normalizes the relapse curve in recently abstinent tobacco smokers with schizophrenia and bipolar disorder

A Eden Evins et al. Schizophr Res. 2017 May.

Abstract

Objective: To compare the effect of maintenance pharmacotherapy on sustained abstinence rates between recently abstinent smokers with schizophrenia and bipolar disorder (SBD) and general population smokers without psychiatric illness.

Method: We performed a person-level, pooled analysis of two randomized controlled trials of maintenance varenicline, conducted in adult smokers with SBD and general population smokers, controlling for severity of dependence. Smokers abstinent after 12-weeks of open varenicline treatment were randomly assigned to ≥12-weeks maintenance varenicline or identical placebo.

Results: In those assigned to maintenance placebo, the abstinence rate at week-24 was lower in those with SBD than for those without psychiatric illness (29.4±1.1% vs. 61.8±0.4%, OR:0.26, 95% CI: 0.13, 0.52, p<0.001). In smokers assigned to maintenance pharmacotherapy, however, there was no effect of diagnosis on abstinence rates at week-24 (87.2±0.8% vs. 81.9±0.2%, OR: 1.68, 95% CI: 0.53, 5.32, p=0.38). Time to first lapse was shortest in those with SBD assigned to maintenance placebo (Q1=12days, 95%CI: 4, 16), longer in those without psychiatric illness assigned to maintenance placebo (Q1=17days, 95%CI: 17, 29), still longer in general-population smokers assigned to maintenance varenicline (Q1=88, 95% CI:58,91, and longest in those with SBD who received maintenance varenicline (Q1>95days, 95%CI:non-est), (Χ23df=96.99, p<0.0001; all pairwise comparisons p<0.001).

Conclusions: Following a standard 12-week course of pharmacotherapy, people with schizophrenia and bipolar disorder were more likely to relapse to smoking without maintenance varenicline treatment. Maintenance pharmacotherapy could improve longer-term tobacco abstinence rates and reduce known smoking-related health disparities in those with SMI.

Keywords: Maintenance treatment; Nicotine; Relapse; Schizophrenia; Tobacco; Varenicline.

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Figures

Figure 1
Figure 1
Point prevalence abstinence rates at each study visit in recently abstinent smokers with or without schizophrenia or bipolar disorder (SMI) during maintenance treatment with varenicline or placebo. Error bars represent standard deviations around the estimated mean proportion of abstinent participants from 50 imputed data sets.
Figure 2
Figure 2
Duration of continuous abstinence, censored at first lapse, in recently abstinent smokers with and without schizophrenia or bipolar disorder (SBD) assigned to varenicline or placebo Dotted segments in each line are plotted across intervals for which the survival estimates are not defined.
See this image and copyright information in PMC

References

    1. Anthenelli RM, Benowitz NL, West R, St Aubin L, McRae T, Lawrence D, Ascher J, Russ C, Krishen A, Evins AE. Neuropsychiatric safety and efficacy of varenicline, bupropion, and nicotine patch in smokers with and without psychiatric disorders (EAGLES): a double-blind, randomised, placebo-controlled clinical trial. Lancet. 2016;387(10037):2507–2520. - PubMed
    1. Anthenelli RM, Morris C, Ramey TS, Dubrava SJ, Tsilkos K, Russ C, Yunis C. Effects of varenicline on smoking cessation in adults with stably treated current or past major depression: a randomized trial. Ann Intern Med. 2013;159(6):390–400. - PubMed
    1. Barr RS, Culhane MA, Jubelt LE, Mufti RS, Dyer MA, Weiss AP, Deckersbach T, Kelly JF, Freudenreich O, Goff DC, Evins AE. The effects of transdermal nicotine on cognition in nonsmokers with schizophrenia and nonpsychiatric controls. Neuropsychopharmacology: official publication of the American College of Neuropsychopharmacology. 2008a;33(3):480–490. - PubMed
    1. Barr RS, Pizzagalli DA, Culhane MA, Goff DC, Evins AE. A single dose of nicotine enhances reward responsiveness in nonsmokers: implications for development of dependence. Biol Psychiatry. 2008b;63(11):1061–1065. - PMC - PubMed
    1. Chengappa KN, Perkins KA, Brar JS, Schlicht PJ, Turkin SR, Hetrick ML, Levine MD, George TP. Varenicline for smoking cessation in bipolar disorder: a randomized, double-blind, placebo-controlled study. The Journal of clinical psychiatry. 2014;75(7):765–772. - PubMed

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