Extended Varenicline Use Ups Smoking Abstinence Rates

Findings in mentally ill patients achieving initial smoking abstinence with 12-week treatment

THURSDAY, Jan. 9, 2014 (HealthDay News) -- Extended use of the smoking cessation medication varenicline improves abstinence rates among the mentally ill, according to a study published in the Jan. 8 issue of the Journal of the American Medical Association, a theme issue on tobacco control.

A. Eden Evins, M.D., M.P.H., from Massachusetts General Hospital in Boston, and colleagues recruited 87 smokers with schizophrenia or bipolar disease who met abstinence criteria following participation in a 12-week clinical trial of varenicline. Participants were randomized to receive cognitive behavioral therapy and varenicline (1 mg; two per day) or placebo from weeks 12 to 52. After discontinuation of treatment, participants were followed up to week 76.

The researchers found that 61 participants completed the relapse-prevention phase and 26 discontinued participation (seven varenicline and 19 placebo). The participants who discontinued the treatment were considered to have relapsed for the analyses, with 18 of them having relapsed prior to dropout. Point-prevalence abstinence rates were 60 percent in the varenicline group and 19 percent in the placebo group at week 52 (odds ratio, 6.2). In the varenicline group, 45 percent were continuously abstinent from week 12 through 64, compared to 15 percent in the placebo group (odds ratio, 4.6). Treatment effects on psychiatric symptom ratings and psychiatric adverse events were similar between the groups.

"Among smokers with serious mental illness who attained initial abstinence with standard treatment, maintenance pharmacotherapy with varenicline and cognitive behavioral therapy improved prolonged tobacco abstinence rates compared with cognitive behavioral therapy alone after one year of treatment and at six months after treatment discontinuation," the authors write.

Several authors disclosed financial ties to pharmaceutical companies, including Pfizer, which partially funded the study and manufactures varenicline.

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