title: 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 1:1 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.
authors.affiliation: From the Social Aetiology of Mental Illness CIHR Training Program (PK), Addictions Program (SV, LZ, PS), and Health Systems & Health Equity Research (KM), Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry (PK, KM, PS), Department of Pharmacology and Toxicology (LZ), Dalla Lana School of Public Health (MC, PS), and Department of Family and Community Medicine (PS), University of Toronto, Toronto, Ontario, Canada; and Ontario Tobacco Research Unit (MC, PS), Toronto, Ontario, Canada.
authors.forename: Pamela
authors.initials: P
authors.lastname: Kaduri
authors.forename: Sabrina
authors.initials: S
authors.lastname: Voci
authors.forename: Laurie
authors.initials: L
authors.lastname: Zawertailo
authors.forename: Michael
authors.initials: M
authors.lastname: Chaiton
authors.forename: Kwame
authors.initials: K
authors.lastname: McKenzie
authors.forename: Peter
authors.initials: P
authors.lastname: Selby
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000150:complications*; D008875:Middle Aged; D018722:Nicotinic Agonists / Q000627:therapeutic use*; D012189:Retrospective Studies; D012907:Smoking / Q000188:drug therapy / Q000523:psychology; D016540:Smoking Cessation / Q000379:methods*; D061485:Tobacco Use Cessation Devices; D016896:Treatment Outcome; D000068580:Varenicline / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D018722:Nicotinic Agonists; D000068580:Varenicline