Efficacy and tolerability of pharmacotherapy for smoking cessation in adults with serious mental illness: a systematic review and network meta-analysis

Emmert Roberts; A Eden Evins; Ann McNeill; Debbie Robson

doi:10.1111/add.13236

Efficacy and tolerability of pharmacotherapy for smoking cessation in adults with serious mental illness: a systematic review and network meta-analysis

Addiction. 2016 Apr;111(4):599-612. doi: 10.1111/add.13236. Epub 2016 Jan 19.

Authors

Emmert Roberts¹, A Eden Evins², Ann McNeill³, Debbie Robson⁴

Affiliations

¹ Academic Clinical Fellow in Psychiatry, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
² William Cox Family Associate Professor of Psychiatry in the Field of Addiction Medicine, Harvard Medical School, Boston, MA, USA.
³ Professor of Tobacco Addiction, National Addiction Centre, Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
⁴ Senior Post-Doctorate Researcher in Tobacco Addiction, National Addiction Centre, Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.

Abstract

Background and aims: To assess the efficacy and tolerability of adjunctive pharmacotherapy for smoking cessation in adults with serious mental illness (SMI) by means of a systematic review and network meta-analysis.

Method: We searched Embase, Medline, PsychINFO and the Cochrane Central Register of Controlled Trials from database inception to 1 December 2014 for randomized controlled trials (RCTs) published in English. We included all studies of smokers with SMI (including schizophrenia, schizoaffective disorder, bipolar disorder, delusional disorder and depressive psychoses) who were motivated to quit smoking. Pharmacotherapies included nicotine replacement therapy (NRT), bupropion and varenicline delivered as monotherapy or in combination compared with each other or placebo. The efficacy outcome was self-reported sustained smoking cessation, verified biochemically at the longest reported time-point. The tolerability outcome was number of patients discontinuing the trial due to any adverse event.

Results: Seventeen study reports were included, which represented 14 individual RCTs. No trials were found in patients with depressive psychoses, delusional disorder or that compared NRT monotherapy with placebo. A total of 356 and 423 participants were included in the efficacy and tolerability analyses, respectively. From the network meta-analysis, both bupropion and varenicline were more effective than placebo [odds ratio (OR) = 4.51, 95% credible interval (CrI) = 1.45-14.04 and OR = 5.17, 95% CrI = 1.78-15.06, respectively]. Data were insensitive to an assessment of varenicline versus bupropion (OR = 1.15, 95% CrI = 0.24-5.45). There were no significant differences in tolerability. All outcomes were rated by GRADE criteria as very low quality.

Conclusions: The limited evidence available to date suggests that bupropion and varenicline are effective and tolerable for smoking cessation in adults with serious mental illnesses.

Keywords: Bupropion; NRT; serious mental illness; smoking cessation; tobacco; varenicline.

Publication types

Meta-Analysis
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Review
Systematic Review

MeSH terms

Bupropion / therapeutic use
Humans
Mental Disorders / complications*
Nicotinic Agonists / therapeutic use
Smoking Cessation / methods*
Tobacco Use Cessation Devices*
Tobacco Use Disorder / complications*
Tobacco Use Disorder / drug therapy*
Treatment Outcome
Varenicline / therapeutic use

Substances

Nicotinic Agonists
Bupropion
Varenicline

Abstract

Publication types

MeSH terms

Substances

Grants and funding