Smoking Cessation: Better Alternatives to Nicotine Replacement

Varenicline and bupropion may be safer for people who are quitting smoking than nicotine replacement therapy. Daniel Kotz, PhD, Institute of General Practice, Medical Faculty of the Heinrich-Heine University in Dusseldorf, Germany, and colleagues performed a retrospective study to determine if varenicline is associated with adverse cardiovascular and/or neuropsychiatric events. The results were published in The Lancet Respiratory Medicine online, on September 15, 2015.

The researchers used data from 164,766 patients who were included in the QResearch database. The participants were between the ages of 18 and 100 years, and had received a prescription for nicotine replacement therapy (NRT), varenicline, or bupropion. The researchers followed the patients for 6 months to find out if they suffered cardiovascular or neuropsychiatric events.

In the context of this study, adverse cardiovascular events included ischemic heart disease, cerebral infarction, heart failure, peripheral vascular disease, and cardiac arrhythmia; adverse neuropsychiatric events included depression and self-harm. The researchers compared those who were prescribed varenicline and bupropion to a control group of people who received NRT, and analyzed the occurrence of adverse cardiovascular and neuropsychiatric events separately.

Of the total, 106,759 patients received prescriptions for NRT, 6,557 took bupropion, and 51,450 were prescribed varenicline between the dates of January 1, 2007, and June 30, 2012. The researchers were clear about the results of their analysis, saying, “We noted no evidence of any increased risk of cardiovascular or neuropsychiatric adverse events in smokers using varenicline or bupropion when compared with NRT users.” In fact, the risk of some of the adverse events -- depression and ischemic heart disease -- was lower for patients taking varenicline and bupropion than for those in the NRT group.

One surprising finding was the difference in patient characteristics between those who were prescribed either varenicline or bupropion and those who were prescribed NRT. Generally, NRT users were older and more socioeconomically deprived, and showed a higher prevalence of all of the cardiovascular and neuropsychiatric risk factors and comorbid diseases.” The statistical models and methods that the researchers used balanced those differences, however.

Although this is one of the largest studies performed on this topic, it does have some limitations. The observational design and the fact that the analysis depended on data that is routinely collected. Despite those limitations, the researchers concluded that physicians have an opportunity to prescribe varenicline more broadly.