Key result
NRT linked to ~29% lower risk of metabolic syndrome criteria vs varenicline in schizophrenia.
Why the study?
Does nicotine replacement therapy compared to varenicline reduce the risk of developing metabolic syndrome criteria (elevated glucose, cholesterol, or blood pressure) in smokers with schizophrenia taking second-generation antipsychotics?
Cohort (n=580)
Yes
Does nicotine replacement therapy compared to varenicline reduce the risk of developing metabolic syndrome criteria (elevated glucose, cholesterol, or blood pressure) in smokers with schizophrenia taking second-generation antipsychotics?
Among smokers with schizophrenia on second-generation antipsychotics, nearly half developed metabolic syndrome components within one year of initiating smoking cessation pharmacotherapy, with lower risk observed for NRT compared to varenicline.
Answers are grounded in this paper and cite their sources.
Should not yet change prescribing; hypothesis-generating for NRT's potential metabolic advantage over varenicline in schizophrenia.
Background: Schizophrenic patients have a lot higher smoking rates when compared to people in the general population. A variety of pharmaceutical cessation aids are available, which include nicotine replacement therapy (NRT), Bupropion SR, and Varenicline. Our objective was to assess which cessation medication would have lower risks in developing risk factors of cardiovascular diseases. Methods: A population-based retrospective cohort study was conducted using the General Electric (GE) electronic medical record database (1995-2011). The cohort consisted of patients with a diagnosis of schizophrenia or schizoaffective disorder (ICD-9 code 295.00-295.99) and who had newly initiated use of any smoking cessation medication. We excluded our cohort who (1) were not prescribed atypical antipsychotics and (2) already had diagnosis of diabetes, hyperlipidemia or hypertension prior to index date. Follow up period was from 12 weeks onwards index date up to one year. The hazard ratio of developing cardiovascular risks was assessed using Cox proportional hazards regression model after controlling for other covariates. Results: A total of 580 patients were included in our cohort. Among those, nearly half (n=276, 47.59%) developed one or more criteria of the metabolic syndromes. We found that smokers who were prescribed NRT were less likely to develop metabolic syndromes as compared to those who were prescribed Varenicline. Conclusions: Physicians are advised to carefully weigh the risks against the benefits before prescribing cessation medications since risks for metabolic syndromes were found to be very high. Healthcare providers should monitor patients’ lab data regularly as this minority population is under higher risks.
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Wu IH (2017) conducted a cohort in Schizophrenia or schizoaffective disorder in smokers (n=580). Nicotine replacement therapy (NRT) vs. Varenicline was evaluated on Development of cardiovascular risk factors / metabolic syndrome criteria (elevated fasting glucose ≥110 mg/dL or diabetes diagnosis/medication, elevated triglycerides ≥150 mg/dL or hyperlipidemia diagnosis/medication, or elevated blood pressure ≥130/85 mmHg or hypertension diagnosis) (HR 0.71, 95% CI 0.54-0.94, p=≤0.05). Nicotine replacement therapy was associated with a lower risk of developing metabolic syndrome criteria compared to varenicline in smokers with schizophrenia.
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