Pharmacotherapy for smoking cessation in schizophrenia: a systematic review

ABSTRACT

Introduction

Rates of tobacco smoking are high in people with schizophrenia with greater difficulty of quitting smoking compared to the general population, which also relate to the increased cardiovascular and cancer risks in this co-occurring disorder. Therefore, effective smoking cessation pharmacotherapies addressing tobacco co-morbidity are imperative.

Areas covered

In this review, the authors performed an extensive systematic electronic literature review examining the efficacy and safety of first-line pharmacotherapies for smoking cessation, including varenicline, sustained-release bupropion, and nicotine replacement therapies (NRT) using continuous abstinence rates over 10-12-week periods in smokers with schizophrenia. Twelve trials reporting smoking cessation outcomes using interventions in schizophrenia were included and risk ratio (RR) was used.

Expert opinion

Our findings support the efficacy and safety of first-line pharmacotherapies for the treatment of tobacco use disorder in smokers with schizophrenia. Further research on the long-term effectiveness and safety of these agents in community samples is warranted. Smoking cessation pharmacotherapies may warrant the consideration of the emerging use of electronic nicotine delivery systems while neuromodulation techniques also offer promise.

KEYWORDS:

• Schizophrenia
• smoking cessation
• varenicline
• bupropion
• nicotine replacement therapy
• risk ratios

Declaration of interest

Dr T George reports that he has funding support from Pfizer Inc for tobacco-related research and is a consultant for Novartis. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Article highlights

• Rates of tobacco smoking amongst those with schizophrenia (~45–88%) are three times higher than the general population (<16%). Moreover, greater difficulty of quitting smoking is prevalent amongst this co-occurring disorder.

• One or more first-line pharmacotherapies for smoking cessation are recommended for patients, including varenicline, sustained-release bupropion (SR), and nicotine replacement therapies (NRT).

• This review examined the efficacy and safety of these pharmacotherapies using continuous abstinence rates (over 10–12 weeks) in smokers with schizophrenia.

• Varenicline and bupropion SR are both effective pharmacotherapies for smoking cessation in smokers with schizophrenia as shown by significant risk ratios when compared to placebo. These treatments are also well tolerated and safe.

• Medications in combination (bupropion and NRTs) are also an effective treatment option that should be considered for patients motivated to quit smoking.

This box summarizes the key points contained in the article.

Supplementary Material

Supplemental data for this article can be accessed here.

Additional information

Funding

This article was supported by an Institute of Medical Sciences Graduate Fellowship from the University of Toronto and a Canadian Institute of Health Research (CIHR) Pre-Doctoral Fellowship (to Ms. Kozak), a CIHR Operating Grant [MOP#115145] and a National Institute of Drug Abuse (NIDA) grant [R21-DA-043949] (to Dr. George).