Safety and efficacy of first-line smoking cessation pharmacotherapies in bipolar disorders: Subgroup analysis of a randomized clinical trial

Heffner, Jaimee L.; Evins, A. Eden; Russ, Cristina; Lawrence, David; Ayers, Catherine R.; McRae, Thomas; Aubin, Lisa St; Krishen, Alok; West, Robert; Anthenelli, Robert M.

doi:10.1016/j.jad.2019.06.008

Cited by 18 publications

(13 citation statements)

References 32 publications

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“…In conclusion, prospective studies are necessary to confirm our results and to assess causality of our findings (e.g., metabolic syndrome and smoking status). Nevertheless, this study stresses the necessity to encourage smoking cessation for BD individuals, especially since recent randomized controlled trials demonstrated efficacy and security of therapies for smoking cessation in these patients 2,21,26 . Our findings suggest that quitting smoking may be more difficult for the most severe patients, but that patients with BD as a group are expected to benefit from quitting regarding their psychiatric and metabolic health.…”

Section: Discussionmentioning

confidence: 72%

Physical and mental health status of former smokers and non‐smokers patients with bipolar disorder

Nobile,

Godin,

Gard

et al. 2023

Acta Psychiatr Scand

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Objectives Up to 70% individuals with bipolar disorder (BD) are lifetime tobacco smokers, a major modifiable risk factor for morbidity. However, quitting smoking is rarely proposed to individuals with BD, mainly because of fear of unfavorable metabolic or psychiatric changes. Evaluating the physical and mental impact of tobacco cessation is primordial. The aim of this study was to characterize the psychiatric and nonpsychiatric correlates of tobacco smoking status (never‐ vs. current vs. former smokers) in individuals with BD. Methods 3860 individuals with ascertained BD recruited in the network of Fondamental expert centers for BD between 2009 and 2020 were categorized into current, former, and never tobacco smokers. We compared the sociodemographic and clinical characteristics assessed by standard instruments (e.g., BD type, current symptoms load, and non‐psychiatric morbidity—including anthropometric and biological data) of the three groups using multinomial regression logistic models. Corrections for multiple testing were applied. Results Current smokers had higher depression, anxiety, and impulsivity levels than former and never‐smokers, and also higher risk of comorbid substance use disorders with a gradient from never to former to current smokers—suggesting shared liability. Current smokers were at higher risk to have a metabolic syndrome than never‐smokers, although this was only evidenced in cases, who were not using antipsychotics. Conclusions Tobacco smoking was associated with high morbidity level. Strikingly, as in the general population, quitting smoking seemed associated with their return to the never‐smokers' levels. Our findings strongly highlight the need to spread strategies to treat tobacco addiction in the BD population.

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Section: Discussionmentioning

confidence: 72%

Physical and mental health status of former smokers and non‐smokers patients with bipolar disorder

Nobile,

Godin,

Gard

et al. 2023

Acta Psychiatr Scand

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“…A post-hoc analysis suggests a higher abstinence rate with varenicline compared to bupropion or NRT ( 79 ), but with all three pharmacological interventions (bupropion, varenicline, NRT) being, by large, equally effective for TUD or ND ( 80 ), safety comes to the fore. NRT has little contraindications or side effects, and can be considered in almost all people with TUD.…”

Section: Treatment Of Comorbid Bipolar Disorder and Tobacco Use Disordermentioning

confidence: 99%

The detrimental effects of smoking on the course and outcome in adults with bipolar disorder—A narrative review

Grunze¹,

Mosolov

Grunze

et al. 2023

Front. Psychiatry

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BackgroundSmoking is a substantial and avoidable risk for physical disability and premature death. Despite a declining tobacco use in the community of developed countries, smoking remains abundant in people with mental disorders. This narrative review highlights the epidemiology, consequences and treatment options of tobacco use disorder (TUD) and nicotine dependence (ND) in people with bipolar disorder (BD).MethodsThe authors conducted a Medline literature search from 1970 to November 2022 using MeSH terms “bipolar disorder” x “smoking” or “nicotine” or “tobacco” that retrieved 770 results. Search results were complemented by additional literature retrieved from examining cross references and by hand search in text books. Finally, 92 references were considered as essential and selected for the educational purpose of this review.Summary of findingsLifetime and point prevalence of smoking in people with BD is in the range of 45–70% and thus about 2–3 times more frequent in BD than in community samples. Smoking, TUD and ND have a detrimental impact both on mental and physical health as well as mortality in people with BD. In the absence of large controlled studies in comorbid BD and TUD or ND, pharmacological treatment follows the individual guidance for each disorder. Community-based psychosocial interventions for TUD and ND appear to be suitable in people with BD, too, as well as Cognitive Behavioral (CBT) or Acceptance and Commitment (ACT) based psychotherapies.ConclusionsSmoking is a modifiable risk factor causing increased risks both for mental and physical health in BD, and deserves more attention in treatment. More treatment research into pharmacological and psychosocial interventions in comorbid BD and TUD or ND are still needed to deliver evidence-based recommendations to physicians.

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“…17 Similarly, it has been reported that individuals with psychiatric disorders are prone to experience relapse of psychiatric symptoms. 18 19 Although many RCTs and post hoc analyses of some RCTs showed consistent results about varenicline safety in subjects with specific psychiatric disorder, [20][21][22][23][24][25][26][27] real-world varenicline safety among these high-risk population is only explored in few studies, 28 29 several related large observational studies of high-quality were all about general population, rather than specific high-risk population. [30][31][32][33] It is important to further investigate the psychiatric safety of varenicline in special patients with COPD or psychiatric disorder or both in real-world setting to strengthen the knowledge of varenicline safety.…”

Section: Introductionmentioning

confidence: 99%

Neuropsychiatric safety of varenicline in the general and COPD population with and without psychiatric disorders: a retrospective cohort study in a real-world setting

et al. 2021

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ObjectivesTo evaluate the real-world association between varenicline and neuropsychiatric adverse events (NPAEs) in general and chronic obstructive pulmonary disease (COPD) population with and without psychiatric disorders compared with nicotine replacement therapy (NRT) to strengthen the knowledge of varenicline safety.DesignA retrospective cohort study.SettingPrescription database IADB.nl, the Netherlands.ParticipantsNew users of varenicline or NRT among general (≥18 years) and COPD (≥40 years) population. Psychiatric subcohort was defined as people prescribed psychotropic medications (≥2) within 6 months before the index date.Outcome measuresThe incidence of NPAEs including depression, anxiety and insomnia, defined by new or naive prescriptions of related medications in IADB.nl within 24 weeks after the first treatment initiation of varenicline or NRT.ResultsFor the general population in non-psychiatric cohort, the incidence of total NPAEs in varenicline (4480) and NRT (1970) groups was 10.5% and 12.6%, respectively (adjusted OR (aOR) 0.85, 95% CI 0.72 to 1.00). For the general population in psychiatric cohort, the incidence of total NPAEs was much higher, 75.3% and 78.5% for varenicline (1427) and NRT (1200) groups, respectively (aOR 0.82, 95% CI 0.68 to 0.99). For the COPD population (1598), there were no differences in the incidence of NPAEs between comparison groups in both the psychiatric cohort (aOR 0.97, 95% CI 0.66 to 1.44) and non-psychiatric cohort (aOR 0.81, 95% CI 0.54 to 1.20). Results from subgroup or sensitivity analyses also did not reveal increased risks of NPAEs but showed decreased risk of some subgroup NPAEs associated with varenicline.ConclusionsIn contrast to the concerns of a possible increased risk of NPAEs among varenicline users, we found a relative decreased risk of total NPAEs in varenicline users of the general population in psychiatric or non-psychiatric cohorts compared with NRT and no difference for NPAEs between varenicline and NRT users in smaller population with COPD.

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Safety and efficacy of first-line smoking cessation pharmacotherapies in bipolar disorders: Subgroup analysis of a randomized clinical trial

Cited by 18 publications

References 32 publications

Physical and mental health status of former smokers and non‐smokers patients with bipolar disorder

Physical and mental health status of former smokers and non‐smokers patients with bipolar disorder

The detrimental effects of smoking on the course and outcome in adults with bipolar disorder—A narrative review

Neuropsychiatric safety of varenicline in the general and COPD population with and without psychiatric disorders: a retrospective cohort study in a real-world setting

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