A Cochrane review [Abstract] 1 included 7 RCTs with a total of 340 patients with schizophrenia. The trials comparing bupropion with placebo showed that smoking cessation rates after bupropion were significantly higher at the end of treatment (RR 2.84; 95% CI 1.61 to 4.99; 7 trials, n=340) and after 6 months (RR 2.78; 95% CI 1.02 to 7.58; 5 trials, n=214). Expired carbon monoxide level and the number of cigarettes smoked daily were significantly lower with bupropion at the end of therapy (MD -10.77, 95% CI -16.52 to -5.01; 3 trials, n=184) but not after 6 months (MD 0.40, 95% CI -5.72 to 6.53; 2 trials, n=104). There were no significant differences in positive, negative and depressive symptoms between bupropion and placebo group. There was no report of major adverse event such as seizures with bupropion.
A secondary analyses of safety and efficacy outcomes by psychiatric diagnosis in EAGLES (Evaluating Adverse Events in a Global Smoking Cessation Study), a 12-week, randomized, double-blind, triple-dummy, placebo- and active (NRT)-controlled trial 2 of varenicline and bupropion with 12-week follow-up, in a subset population with a psychiatric disorder (n = 4092). Primary end-point parameters were incidence of prespecified moderate and severe neuropsychiatric adverse events (NPSAEs) and weeks 9 to 12 continuous abstinence rates. The observed NPSAE incidence across treatments was 5.1% to 6.3% in those with a psychotic disorder (n=390), 4.6% to 8.0% in those with an anxiety disorder (n = 792), and 4.6% to 6.8% in those with a mood disorder (n = 2910). Neither varenicline nor bupropion was associated with significantly increased NPSAEs relative to NRT or placebo in the psychiatric cohort or any psychiatric diagnostic subcohort. There was a significant effect of treatment on continuos abstinence (P < 0.0001) and no significant treatment-by-diagnostic subcohort interaction (P = 0.24). Abstinence rates with varenicline were superior to bupropion, NRT, and placebo, and abstinence with bupropion and NRT was superior to placebo. Within-diagnostic subcohort comparisons of treatment efficacy yielded estimated odds ratios for 9-12 abstinence rates versus placebo of greater than 3.00 for varenicline, greater than 1.90 for bupropion, and greater than 1.80 for NRT for all diagnostic groups.
Comment: The quality of the evidence is downgraded by study quality (inadequate allocation concealment).
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