Abstinence and psychological distress in co-morbid smokers using various pharmacotherapies.
BACKGROUND
Existing trials of varenicline have typically excluded smokers with concurrent medical and psychiatric illnesses and no data exist comparing effectiveness of varenicline with combination pharmacotherapy. This study evaluated abstinence and psychiatric outcomes of various tobacco dependence medications, including varenicline.


METHODS
Retrospective cohort of 723 smokers, most with significant medical and psychiatric comorbidity, was evaluated at the UMDNJ-Tobacco Dependence Clinic from 2006 to 2008. Demographics, measures of tobacco dependence and co-morbidities, and a validated instrument measuring psychological distress (Kessler-6) were obtained. Primary outcome was 7-day point abstinence at 6 months after target quit date.


RESULTS
Cessation medications used included combination pharmacotherapy (39%), single nicotine replacement therapy (NRT) or bupropion (29%), and varenicline (23%), with 9% using no medications. Overall, 23% of patients were abstinent at 6 months. In an adjusted regression model, smokers using varenicline or combination medications were more likely abstinent at 6 months than those using no medications (adjusted odds ratio=2.99; 95% confidence interval=1.20-7.47 and 2.80; 1.15-6.82, respectively), but not statistically higher than those using single medications (AOR=1.70). Age, gender, education, marital status, cigarettes per day, time to first cigarette, night smoking, and menthol smoking were not significantly related to abstinence. Varenicline or combination medications did not significantly increase serious psychological distress over the treatment period compared to other medication options.


CONCLUSIONS
Both varenicline and combination pharmacotherapy were effective and did not increase psychological distress for up to 6 months in smokers with co-morbidities treated at a specialty clinic.
Division of General Internal Medicine, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, 125 Paterson Street, Suite 2300, New Brunswick, NJ 08903, USA. michael.steinberg@umdnj.edu
Michael B
MB
Steinberg
Michelle T
MT
Bover
Donna L
DL
Richardson
Amy C
AC
Schmelzer
Jill M
JM
Williams
Jonathan
J
Foulds
D000328:Adult; D000368:Aged; D001552:Benzazepines / Q000008:administration & dosage; D016642:Bupropion / Q000008:administration & dosage; D015331:Cohort Studies; D015897:Comorbidity; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009538:Nicotine / Q000008:administration & dosage; D011810:Quinoxalines / Q000008:administration & dosage; D012189:Retrospective Studies; D012907:Smoking / Q000188:drug therapy* / Q000453:epidemiology* / Q000523:psychology; D016540:Smoking Cessation / Q000379:methods* / Q000523:psychology; D013315:Stress, Psychological / Q000188:drug therapy* / Q000453:epidemiology* / Q000523:psychology; D016896:Treatment Outcome; D000068580:Varenicline; D055815:Young Adult
D001552:Benzazepines; D011810:Quinoxalines; D016642:Bupropion; D009538:Nicotine; D000068580:Varenicline