Comparative Effectiveness of Smoking Cessation Medications among Schizophrenic Smokers

Abstract

Objectives: To compare short term and long term smoking abstinence with different cessation medications among schizophrenia patients. Methods: A retrospective cohort study was conducted using General Electric (GE) medical records database (1995 - 2011). The cohort consisted of adult smokers with a diagnosis of schizophrenia who newly initiated cessation medication (NRT, Bupropion or Varenicline). Cessation outcome was abstinence. It was measured at 12 weeks and 1 year following the initiation of cessation medications. Logistic regression models were carried out to determine the predictors of short term and long term abstinence. Results: Of the 3,976 patients identified, majority used nicotine replacement therpapy (NRT) (n= 2,590, 65.14%) followed by Bupropion SR (n= 89, 2.24%) and Varenicline (n= 1,164, 29.28%). Although unadjusted analysis showed that abstinence rate was the highest for Varenicline across all cessation regimens (21.04%) in both the short term (21.04%) and the long term follow up (20.07%) among all cessation regimens, statistically significant difference was not detected in the multivariate analysis. Older age (OR= 1.02, 95% CI= 1.01 - 1.03), white race (OR= 1.83, 95% CI= 1.04 - 3.20), western household locations (OR= 2.18, 95% CI= 1.39 - 3.41) and receiving counseling (OR= 0.67, 95% CI= 0.49 - 0.92) were significantly associated with abstinence at week 12. Patients who had a 2nd exposure were less likely to quit compared to those without the 2nd exposure at one year (OR= 0.26, 95% CI= 0.13-0.55). No significant differences were found between cessation medications. Conclusions: There were no statistically significant differences in quitting with type of cessation medication. Predictors of better abstinence identified included older age, white race, western household location, which can help identify subpopulations among schizophrenic patients that are more likely to succeed in quitting. These predictors should be considered when designing future interventions for schizophrenic population as this minority population may need more tailored approaches to achieve a successful cessation outcome.