Efficacy and Safety of Varenicline for Smoking Cessation in Schizophrenia: A Meta-Analysis

Ahmed, Saeed; Virani, Sanya; Kotapati, Vijaya Padma; Bachu, Ramya; Adnan, Mahwish; Khan, Ali Mahmood; Zubair, Aarij; Begum, Gulshan; Kumar, Jeevan; Qureshi, Mustafa; Ahmed, Rizwan

doi:10.3389/fpsyt.2018.00428

Cited by 16 publications

(10 citation statements)

References 66 publications

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“…This is likely the result of earlier reports 9 that suggested use of these medications may increase psychiatric symptoms or events in patients with SMI, however, this has subsequently been refuted. 10 In some cases, prescribing by the mental health team was required to facilitate patient access to NRT; however, this was not a sustainable alternative to a GP prescribing in the long term.…”

Section: Resultsmentioning

confidence: 99%

Challenges and solutions to nicotine replacement therapy access: observations from SCIMITAR+

et al. 2020

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Background Given that smoking results in poor physical and mental health, reducing tobacco harm is of high importance. Recommendations published by the National Institute for Health and Care Excellence to reduce smoking harms included provision of support, use of nicotine containing products and commissioning of smoking cessation services. Aims This report explores the difficulties in obtaining such support, as observed in a recently conducted randomised controlled trial in patients with severe mental ill health, and outlines suggestions to improve facilitation of provision. Method Data collected during the Smoking Cessation Intervention for Severe Mental Ill Health Trial (SCIMITAR+) (trial Registration ISRCTN72955454), was reviewed to identify the difficulties experienced, across the trial, with regards to access and provision of nicotine replacements therapy (NRT). Actions taken to facilitate access and provision of NRT were collated to outline how provision could be better facilitated. Results Access to NRT varied across study settings and in some instances proved impossible for patients to access. Difficulty in access was irrespective of a diagnosis of severe mental ill health. Where NRT was provided, this was not always provided in accordance with NICE guidelines. Conclusions Availability of smoking cessation support, and NRT provision would benefit from being made clearer, simpler and more easily accessible so as to enhance smoking cessation rates.

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Section: Resultsmentioning

confidence: 99%

Challenges and solutions to nicotine replacement therapy access: observations from SCIMITAR+

et al. 2020

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“…While people suffering from SMI continue to smoke at higher rates than the general population, care providers often do not address nicotine addiction in this population because of the common misbelief that treatment could worsen the patient’s mental illness or that the patient lacks the motivation to quit 44. There are, however, no good quality data to support this standpoint 45. In order to increase recruitment of participants with MHDs into smoking cessation trials, it is important to clarify such misapprehensions among healthcare providers and researchers.…”

Section: Discussionmentioning

confidence: 99%

Inequity in smoking cessation clinical trials testing pharmacotherapies: exclusion of smokers with mental health disorders

et al. 2021

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ObjectivesPeople suffering from mental health disorder (MHDs) are often under-represented in clinical research though the reasons for their exclusion are rarely recorded. As they have higher rates of smoking and nicotine dependence, it is crucial that they are adequately represented in clinical trials of established pharmacotherapy interventions for smoking cessation. This review aims to examine the practice of excluding smokers with MHDs and reasons for such exclusion in clinical trials evaluating pharmacotherapy treatments for smoking cessation.Data sourceThe Cochrane database of systematic reviews was searched until September 2020 for reviews on smoking cessation using pharmacotherapies.Study selectionRandomised controlled trials (RCTs) within the selected Cochrane reviews were included.Data extractionConducted by one author and independently verified by three authors.Data synthesisWe included 279 RCTs from 13 Cochrane reviews. Of all studies, 51 (18.3%) explicitly excluded participants with any MHDs, 152 (54.5%) conditionally excluded based on certain MHD criteria and 76 (27.2%) provided insufficient information to ascertain either inclusion or exclusion. Studies of antidepressant medications used for smoking cessation were found to be 3.33 times more likely (95% CI 1.38 to 8.01, p=0.007) to conditionally exclude smokers with MHDs than explicitly exclude compared with studies of nicotine replacement therapy.ConclusionSmokers with MHDs are not sufficiently represented in RCTs examining the safety and effectiveness of smoking cessation medications. Greater access to clinical trial participation needs to be facilitated for this group to better address access to appropriate pharmacotherapeutic interventions in this vulnerable population.

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“…There may be insufficient opportunities for smoking cessation treatment and education, especially for women with schizophrenia. Smoking cessation drugs are reportedly effective and safe in assisting smoking cessation in patients with schizophrenia [37], and these medications might be easily obtained to begin immediate treatment [38]. One meta-analysis showed that the cessation rates after treatment of smoking cessation drugs were significantly higher than placebo treatment (risk ratio: 3.03–4.74) [39].…”

Section: Discussionmentioning

confidence: 99%

Change in smoking cessation stage over 1 year in patients with schizophrenia: a follow up study in Japan

Higuchi¹,

Fujiwara

Nakaya

et al. 2019

BMC Psychiatry

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BackgroundWe performed a follow up study about willingness and behaviors to quit smoking among smokers with schizophrenia in Japan.MethodsParticipants were outpatients with schizophrenia aged 20–69 years who had been visiting the hospital for ≥1 year as of April 1, 2016, and had visited the hospital more than once in the previous 6 months. A baseline survey on smoking behaviors including current smoking status and smoking cessation stage, was administered in 420 participants that were randomly extracted from a patient pool (n = 680) in 2016, and a follow-up survey was administered in 2017. We calculated the distribution and change in smoking cessation stage, number of smokers and nonsmokers after 1 year, and quitting rate from a naturalistic 1-year smoking-cessation follow up.ResultsThe number of baseline respondents was 350; 113 current smokers and 68 former smokers. Among the 113 current smokers, 104 (92.0%) were followed for 1 year, 79 (70.0%) were interested in smoking cessation, and only 7 had received smoking cessation treatments at baseline. Among the tracked 104 participants, only 6 (5.8%) stopped smoking after 1 year. Among the 25 participants who had intentions to quit smoking within 6 months at baseline, 6 (24.0%) maintained their intention to quit smoking for 1 year, and 16 (64.0%) did not maintain their intention to quit smoking.ConclusionsOur findings showed that many smokers with schizophrenia were interested in quitting smoking, but few patients received treatment and actually quit smoking. Timely intervention, including the option to receive smoking cessation treatment, is necessary for those patients with schizophrenia who smoke.Trial registrationUMIN Clinical Trials Registry (UMIN000023874, registered on August 31, 2016).

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Efficacy and Safety of Varenicline for Smoking Cessation in Schizophrenia: A Meta-Analysis

Cited by 16 publications

References 66 publications

Challenges and solutions to nicotine replacement therapy access: observations from SCIMITAR+

Challenges and solutions to nicotine replacement therapy access: observations from SCIMITAR+

Inequity in smoking cessation clinical trials testing pharmacotherapies: exclusion of smokers with mental health disorders

Change in smoking cessation stage over 1 year in patients with schizophrenia: a follow up study in Japan

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