Real-world effectiveness of varenicline versus nicotine replacement therapy in patients with and without psychiatric disorders.

ABSTRACT

OBJECTIVE: To compare the effectiveness and safety of varenicline with nicotine replacement therapy (NRT) among smokers with or without psychiatric disorders attending a storefront smoking cessation clinic in an urban addiction and mental health academic health science center. METHODS: A retrospective chart review was conducted to compare treatment outcomes, demographics, and clinical characteristics for adult smokers prescribed varenicline (n = 98) or NRT (n = 98) between 2007 and 2010. Subjects were matched 11 on age, sex, and year of initial assessment. RESULTS: End-of-treatment quit rates were almost twice as high among those prescribed varenicline (33.7%) versus NRT (18.4%) (RR = 1.83, 95% CI = 1.11-3.03, P = 0.02). After adjusting for several baseline and treatment characteristics, varenicline was still significantly more effective than NRT (ARR = 1.71, 95% CI = 1.05-2.79, P = 0.03). History of psychiatric disorder (excluding substance use disorders) and treatment duration were also independent predictors of end-of-treatment quit rates. Nausea was more commonly reported among those using varenicline (13.3% vs 3.1%, P = 0.009). No single neuropsychiatric adverse effect significantly differed between groups; however, overall reporting of any neuropsychiatric effect was somewhat higher in the varenicline group (31.6% vs 20.4%, P = 0.07). There was one incident of suicidal ideation in each medication group. CONCLUSIONS: Varenicline seems to be more effective than NRT and as safe in real-world settings among patients with and without a history of psychiatric disorder.