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Meta-Analysis
. 2019 Nov 28;9(11):e027389.
doi: 10.1136/bmjopen-2018-027389.

Pharmacological and behavioural interventions to promote smoking cessation in adults with schizophrenia and bipolar disorders: a systematic review and meta-analysis of randomised trials

Robert Pearsall  1   2 , Daniel J Smith  2 , John R Geddes  3
Affiliations
Meta-Analysis

Pharmacological and behavioural interventions to promote smoking cessation in adults with schizophrenia and bipolar disorders: a systematic review and meta-analysis of randomised trials

Robert Pearsall et al. BMJ Open. .

Abstract

Objective: Smoking in people with serious mental illness is a major public health problem and contributes to significant levels of morbidity and mortality. The aim of the review was to systematically examine the efficacy of methods used to aid smoking cessation in people with serious mental illness.

Method: A systematic review and meta-analysis of randomised controlled trials to compare the effectiveness and safety of pharmacological and behavioural programmes for smoking cessation in people with serious mental illness. Electronic databases were searched for trials to July 2018. We used the Cochrane Collaboration's tool for assessing the risk of bias.

Results: Twenty-eight randomised controlled trials were identified. Varenicline increased the likelihood of smoking cessation at both 3 months (risk ratio (RR) 3.56, 95% CI 1.82 to 6.96, p=0.0002) and at 6 months (RR 3.69, 95% CI 1.08 to 12.60, p=0.04). Bupropion was effective at 3 months (RR 3.96, 95% CI 1.86 to 8.40, p=0.0003), especially at a dose of 300 mg/day, but there was no evidence of effect at 6 months (RR 2.22, 95% CI 0.52 to 9.47, p=0.28). In one small study, nicotine therapy proved effective at increasing smoking cessation up to a period of 3 months. Bupropion used in conjunction with nicotine replacement therapy showed more effect than single use. Behavioural and bespoke interventions showed little overall benefit. Side effects were found to be low.

Conclusion: The new information of this review was the effectiveness of varenicline for smoking cessation at both 3 and 6 months and the lack of evidence to support the use of both bupropion and nicotine products for sustained abstinence longer than 3 months. Overall, the review found relatively few studies in this population.

Keywords: bupropion; nicotine replacement; serious mental illness; smoking cessation; varenicline.

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Conflict of interest statement

Competing interests: RP and DJS declared no competing interests. JG has received research funding from MRC, ESRC, NIHR, Stanley Medical Research Institute and has received donations of drugs supplies for trials from Sanofi-Aventis and GSK. He has acted as an expert witness for Dr Reddys.

Figures

Figure 1
Figure 1
Flow chart of the results of the systematic search. NRT, nicotine replacement therapy.
Figure 2
Figure 2
Pooled effect of bupropion vs placebo for smoking cessation at 3 months.
Figure 3
Figure 3
Pooled effect of bupropion vs placebo for smoking cessation at 6 months.
Figure 4
Figure 4
Pooled effect of varenicline vs placebo for smoking cessation at 3 months.
Figure 5
Figure 5
Pooled effect of varenicline vs placebo for smoking cessation at 6 months.
Figure 6
Figure 6
Pooled effect of nicotine replacement therapy vs placebo for smoking cessation at 3 months.
Figure 7
Figure 7
Pooled effect of bupropion only and combined bupropion/nicotine replacement therapy studies vs placebo for smoking cessation at 6 months.
Figure 8
Figure 8
Funnel plots of smoking cessation studies. (A)Funnel plot of comparison: bupropion 3 months. (B) Funnel plot of comparison: bupropion 6 months. (C) Funnel plot of comparison: varenicline 3 months. (D) Funnel plot of comparison: varenicline 6 months. RR, risk ratio.
Figure 9
Figure 9
Risk of bias graph: review authors’ judgements about each risk of bias item presented as percentages across all included studies.
See this image and copyright information in PMC

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