Prescribing Prevalence, Effectiveness, and Mental Health Safety of Smoking Cessation Medicines in Patients With Mental Disorders

Abstract

Objective We conducted a prospective cohort study of the Clinical Practice Research Database to estimate rates of varenicline and nicotine replacement therapy (NRT) prescribing and the relative effects on smoking cessation, and mental health. Methods We used multivariable logistic regression, propensity score matched regression, and instrumental variable analysis. Exposure was varenicline or NRT prescription. Mental disorders were bipolar, depression, neurotic disorder, schizophrenia, or prescriptions of antidepressants, antipsychotics, hypnotics/anxiolytics, mood stabilizers. Outcomes were smoking cessation, and incidence of neurotic disorder, depression, prescription of antidepressants, or hypnotics/anxiolytics. Follow-ups were 3, 6, and 9 months, and at 1, 2, and 4 years. Results In all patients, NRT and varenicline prescribing declined during the study period. Seventy-eight thousand four hundred fifty-seven smokers with mental disorders aged ≥18 years were prescribed NRT (N = 59 340) or varenicline (N = 19 117) from September 1, 2006 to December 31, 2015. Compared with smokers without mental disorders, smokers with mental disorders had 31% (95% CI: 29% to 33%) lower odds of being prescribed varenicline relative to NRT, but had 19% (95% CI: 15% to 24%) greater odds of quitting at 2 years when prescribed varenicline relative to NRT. Overall, varenicline was associated with decreased or similar odds of worse mental health outcomes than NRT in patients both with and without mental disorders, although there was some variation when analyses were stratified by mental disorder subgroup. Conclusions Smoking cessation medication prescribing may be declining in primary care. Varenicline was more effective than NRT for smoking cessation in patients with mental disorders and there is not clear consistent evidence that varenicline is adversely associated with poorer mental health outcomes. Implications Patients with mental disorders were less likely to be prescribed varenicline than NRT. We triangulated results from three analytical techniques. We found that varenicline was more effective than NRT for smoking cessation in patients with mental disorders. Varenicline was generally associated with similar or decreased odds of poorer mental health outcomes (ie, improvements in mental health) when compared with NRT. We report these findings cautiously as our data are observational and are at risk of confounding.

Mental health, smoking and poverty: benefits of supporting smokers to quit

“…Primary care data for over 200 000 smokers shows that smokers with mental health conditions were 31% less likely to be prescribed varenicline than NRT, despite varenicline being more effective. 32 Smokers with mental health conditions who were prescribed varenicline were 19% more likely to have successfully quit at 2-year follow-up, compared with those prescribed NRT. 32 These policies must be addressed to ensure that all smokers are being offered the best support available to quit, in line with NICE guidance.…”

“…32 Smokers with mental health conditions who were prescribed varenicline were 19% more likely to have successfully quit at 2-year follow-up, compared with those prescribed NRT. 32 These policies must be addressed to ensure that all smokers are being offered the best support available to quit, in line with NICE guidance. Smokers with mental health conditions are often more heavily addicted, 2 and ensuring they have access to the most effective pharmacotherapy is essential to supporting quit attempts.…”

“…However, evidence shows that varenicline is not associated with negative outcomes for people with mental health conditions. [30][31][32] As reflected in the Royal College of Psychiatrists' position statement on prescribing of varenicline: 'varenicline is a generally safe and well-tolerated medication which has been proven to increase rates of smoking cessation in psychiatric and non-psychiatric populations'. 33 However, prescribing rates for varenicline are falling fast, particularly for people with mental health conditions.…”

Views about integrating smoking cessation treatment within psychological services for patients with common mental illness: a multi-perspective qualitative study

“…However, smoking rates in people with common mental illness, like depression and anxiety, are at least twice the rate of those without common mental illness. For example, in the UK 34% of people with depression, and 29% of people with anxiety smoke 5 . This population is more heavily addicted, suffers from worse withdrawal 6 , and has a 19% reduction in the odds of achieving abstinence when making a quit attempt 7 , but are as motivated to do so as the general population 8 .…”

Smoking-Cessation Interventions for Hospitalized Patients with Mental Disorder: Systemic Review and Meta-Analysis

“…금연 중재 연구가 적었으나 2016년 정서 장애 환자가 70%정도 포함된 대규모 연구(Anthenelli et al, 2016)에서 금연 약물 치료의 효과가 입증되고 부작용 이 높지 않다는 결과 발표 이후 정서장애 흡연자를 대상으 로 한 연구가 점차 증가하고 있다(Taylor et al, 2019). 중재법 모두 금연 성공 가능성을 높였고 이는 입원 기간 동안 제공하는 금연 상담 강도의 중요성을 보여주었 다.…”