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

SCHIZOPHRENIA RESEARCH

卷:183

Article

Evins, A. Eden^1,2  Hoeppner, Susanne S.^1,2  Schoenfeld, David A.^2,3  Hoeppner, Bettina B.^1,2  Cather, Corinne^1,2  Pachas, Gladys N.^1,2  Cieslak, KristinaM.^1,2  Maravic, Melissa Culhane^1,2 

[1] Massachusetts Gen Hosp, Dept Psychiat, Boston, MA 02114 USA

[2] Harvard Med Sch, Boston, MA USA

[3] Massachusetts Gen Hosp, Dept Med, Boston, MA 02114 USA

关键词: Schizophrenia;    Tobacco;    Nicotine;    Relapse;    Varenicline;    Maintenance treatment;   

DOI  :  10.1016/j.schres.2016.11.018

来源: Elsevier

【 摘 要 】

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 = 12 days, 95% CI: 4, 16), longer in those without psychiatric illness assigned to maintenance placebo (Q1= 17 days, 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 > 95 days, 95% CI: non-est), (chi(2)(df)=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. (C) 2016 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

【 授权许可】

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