A Double-blind Placebo-Controlled Trial of Bupropion Sustained-Release for Smoking Cessation in Schizophrenia

Abstract

The objective of this study was to examine the efficacy of bupropion for smoking cessation in patients with schizophrenia. Adults with schizophrenia who smoked more than 10 cigarettes per day and wished to try to quit smoking were recruited from community mental health centers, enrolled in a 12-week group cognitive behavioral therapy intervention, and randomly assigned to receive either bupropion sustained-release 300 mg/d or identical placebo. Fifty-three adults, 25 on bupropion and 28 on placebo, were randomized, completed at least 1 postbaseline assessment and were included in the analysis. The primary outcome measures were 7-day point prevalence abstinence in the week after the quit date (week 4) and at the end of the intervention (week 12). Subjects in the bupropion group were significantly more likely to be abstinent for the week after the quit date (36% [9/25] vs. 7% [2/28], P = 0.016) and at end of the intervention (16% [4/25] vs. 0%, P = 0.043). Subjects in the bupropion group also had a higher rate of 4-week continuous abstinence (weeks 8-12) (16% [4/25] vs. 0%, P = 0.043) and a longer duration of abstinence (4.2 [3.2] weeks vs. 1.8 [0.96] weeks, t = 2.30, P = 0.037). The effect of bupropion did not persist after discontinuation of treatment. Subjects in the bupropion group had no worsening of clinical symptoms and had a trend toward improvement in depressive and negative symptoms. We conclude that bupropion does not worsen clinical symptoms of schizophrenia and is modestly effective for smoking cessation in patients with schizophrenia. The relapse rate is high after treatment discontinuation.

A Placebo-Controlled Trial of Bupropion Combined with Nicotine Patch for Smoking Cessation in Schizophrenia

“…In this trial, significant effects of the combination were noted on short-term abstinence during the trial (p<0.03; NNT=5), but the difference between groups on long-term abstinence (13.8% vs 0.0%) was not significant (p=0.11; NNT=8). Our long-term abstinence rate with the combination treatment was consistent with previous trials in schizophrenia (0-13%) [14][15][16]18]. Accordingly, our findings suggest that the combination may be a clinically useful treatment for tobacco dependence in smokers with schizophrenia, and appears to be safe and well-tolerated.…”

“…Several controlled studies of nicotine replacement therapies (NRTs) or BUP for smoking cessation or reduction have been conducted in schizophrenia [12][13][14][15][16][17][18]. Short-term cessation rates in these studies was less than 25% overall.…”

The Effects of Transdermal Nicotine on Cognition in Nonsmokers with Schizophrenia and Nonpsychiatric Controls

“…Individuals with schizophrenia who are able to quit smoking appear to be less cognitively impaired than those who are unable to quit smoking (Dolan et al, 2004;Evins et al, 2005a). Specifically, better performance in CPT reaction time variability has been shown to predict abstinence in smoking cessation studies in those with schizophrenia (Evins et al, 2005a), indicating that exsmokers with schizophrenia may have less cognitive impairment than smokers. Secondly, the control group was significantly younger, had a higher mean IQ and lower rate of previous smoking than the schizophrenia group.…”

“…Findings in nonsmokers with schizophrenia may not generalize to smokers with schizophrenia because smokers with schizophrenia may have pathophysiological differences compared with nonsmokers, including more severe disease (Goff et al, 1992;McEvoy et al, 1999). Individuals with schizophrenia who are able to quit smoking appear to be less cognitively impaired than those who are unable to quit smoking (Dolan et al, 2004;Evins et al, 2005a). Specifically, better performance in CPT reaction time variability has been shown to predict abstinence in smoking cessation studies in those with schizophrenia (Evins et al, 2005a), indicating that exsmokers with schizophrenia may have less cognitive impairment than smokers.…”

Lack of beneficial galantamine effect for smoking behavior: A double-blind randomized trial in people with schizophrenia

“…This is in contrast to cessation rates from alcohol and drug use disorders of over 40% (de Leon et al 2005) in this population. Furthermore, even when interventions are been found to be modestly effective in double-blind trials, relapse is very common once the intervention is discontinued (Evins et al 2005, Evins et al 2007. Others have reported decreases in total cigarette consumption but little evidence is available to suggest that total abstinence is easily achieved even with combined pharmacologic agents currently available and behavioral interventions , Evins et al 2007, Weiner et al 2001.…”