Varenicline in the routine treatment of tobacco dependence: a pre–post comparison with nicotine replacement therapy and an evaluation in those with mental illness

Authors

  • John A. Stapleton,

    Corresponding author
    1. Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, UK,
    2. South London and Maudsley NHS Foundation Trust, Tobacco Dependence Clinic, UK and
    3. Kings College London, Department of Psychological Medicine, Institute of Psychiatry, UK
      John Stapleton, Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, 2-16 Torrington Place, London WC1E 6BT, UK. E-mail: j.stapleton@ucl.ac.uk
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  • Lucy Watson,

    1. South London and Maudsley NHS Foundation Trust, Tobacco Dependence Clinic, UK and
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  • Lucy I. Spirling,

    1. South London and Maudsley NHS Foundation Trust, Tobacco Dependence Clinic, UK and
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  • Robert Smith,

    1. South London and Maudsley NHS Foundation Trust, Tobacco Dependence Clinic, UK and
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  • Andrea Milbrandt,

    1. South London and Maudsley NHS Foundation Trust, Tobacco Dependence Clinic, UK and
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  • Marina Ratcliffe,

    1. South London and Maudsley NHS Foundation Trust, Tobacco Dependence Clinic, UK and
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  • Gay Sutherland

    1. South London and Maudsley NHS Foundation Trust, Tobacco Dependence Clinic, UK and
    2. Kings College London, Department of Psychological Medicine, Institute of Psychiatry, UK
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John Stapleton, Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, 2-16 Torrington Place, London WC1E 6BT, UK. E-mail: j.stapleton@ucl.ac.uk

ABSTRACT

Aims  To compare the effectiveness of varenicline with nicotine replacement for smoking cessation and to evaluate the safety and effectiveness of varenicline in people with mental illness.

Design  Evaluation of consecutive routine cases before and after the introduction of varenicline.

Setting  National Health Service (NHS) tobacco dependence clinic in London, UK.

Participants  A total of 412 cases receiving routine care.

Intervention  Seven group support sessions over 6 weeks with either nicotine replacement therapy (NRT) (n = 204) or varenicline (n = 208).

Measurements  Verified abstinence 4 weeks after quit day, severity of withdrawal symptoms, incidence and severity of adverse drug symptoms, cost per patient treated and cost per successful short-term quitter.

Findings  Short-term cessation rates were higher with varenicline than NRT (odds ratio = 1.70, 95% confidence interval = 1.09–2.67). Varenicline was equally effective in those with and without mental illness. Craving to smoke, but not adverse mood, was less severe with varenicline than NRT. The cost per quitter was similar for varenicline and NRT. There was a higher incidence of adverse drug symptoms among those taking varenicline, but these were tolerated by most smokers. There was no evidence that varenicline exacerbated mental illness.

Conclusions  In this setting and with group support varenicline appears to improve success rates over those achieved with NRT, and is equally effective and safe in those with and without a mental illness.

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