PARIS – Enhancing a smoking cessation program with a daily dose of bupropion enabled a small group of schizophrenia patients to stay off nicotine in a randomized, placebo-controlled trial reported by Dr. Tony P. George at the annual congress of the European College of Neuropsychopharmacology.
All patients received 10 weeks of behavioral therapy during which they wore a transdermal nicotine patch 24 hours a day. In addition, 27 patients took 300 mg of bupropion SR daily, while 27 patients received a placebo.
At the conclusion of the intervention, 30% of the bupropion group and 5% of the placebo group had quit smoking. Six months later, 20% of the patients given bupropion were still not smoking. Not one member of the placebo group was able to stay off cigarettes that long.
“It is possible to get these difficult-to-treat patients to quit–more so in the short term, but also in the long term,” said Dr. George, recently appointed professor and chair of addiction psychiatry at the University of Toronto.
“This is very exciting to us,” he added. “This conclusion seems to be superior to the patch alone for short- and long-term outcomes.”
The research was done at Yale University, New Haven, Conn., where Dr. George had conducted previous studies of cognitive-behavioral therapy and the nicotine patch as smoking cessation strategies for patients with schizophrenia.
The National Institute on Drug Abuse funded the new trial. Dr. George presented preliminary results in Paris. However, he said that enrollment was nearly complete and that he did not expect any significant changes in the outcomes.
Patients in both arms of the study were about 40 years old on average and smoked about 24 cigarettes per day.
Schizophrenia patients have much higher rates of smoking and nicotine dependence than does the general population, according to Dr. George. They also have much more difficulty quitting smoking for reasons that may be related to the disorder. His earlier work suggests, for example, that cigarette smoking can enhance prefrontal cortical dopamine function and visual spatial memory in those with schizophrenia.
Nonetheless, Dr. George said in an interview at the meeting that many patients are highly motivated to quit because of the impact on their health–in particular, the risk of early death from cancer and cardiovascular diseases.
“It [nicotine] is helping them in the short term, but it is going to kill them in the end,” he said.
Dr. George said he plans to look at other nicotinic acetylcholine receptor agents in future studies as well as atomoxetine and the role of genetic polymorphisms in moderating treatment response.
“Developing better treatments will depend on the pathophysiologic relationship between smoking and the disorder itself–and possibly other disorders,” Dr. George said.
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