EFFICACY AND SAFETY OF VARENICLINE FOR SMOKING CESSATION IN SCHIZOPHRENIA: A DETAILED REVIEW

Mrinmoy Kumar Ghosh*, Sohome Das, Moumita Karmakar, Binaya Kumar Sethy

ABSTRACT

Individuals with schizophrenia smoke at higher rates (58%– 88%) than the general population, and have difficulty quitting. Smoking is a major public health problem and is a leading cause of preventable death. Despite the high prevalence of smoking among people with schizophrenia, there are few effective treatments for smoking cessation in this population. Varenicline has not been studied extensively in patients with mental illnesses, particularly in those with schizophrenia, a population with an exceptionally high prevalence of nicotine addiction. Although case reports and small case series initially suggested that varenicline may be associated with increased risk of neuropsychiatric adverse effects in psychiatric populations, subsequent studies from case reports and case series to larger clinical trials have demonstrated that the medication can be safely administered to aid schizophrenia patients with smoking cessation with minimal adverse events. Thus, further research is needed. The objective of this study is to evaluate the efficacy of varenicline for smoking cessation among individuals with schizophrenia. Among the 828 surveyed articles, only four randomized controlled trials (RCTs) with a total of 239 participants met the criteria for meta-analysis. The results of the meta-analysis revealed that compared to placebo, varenicline treatment significantly decreased the number of cigarettes consumed per day [standardized mean difference (SMD) (95% confidence interval (CI)) = 0.89 (0.57–1.22)] and the expired carbon monoxide levels [SMD (95% CI) = 0.50 (0.06–0.94)] in patients with schizophrenia. Despite the small sample size of studies included in the meta-analysis, our findings suggest that varenicline is an effective and safe drug to assist smoking cessation among patients with schizophrenia. Further well-designed, large-scale randomized controlled trials are needed to validate these results.

Keywords: Varenicline, schizophrenia, randomized controlled trials, meta-analysis, standardized mean difference.