• Pamela Kaduri, Sabrina Voci, Laurie Zawertailo, Michael Chaiton, Kwame McKenzie, and Peter Selby.
• From the Social Aetiology of Mental Illness CIHR Training Program (PK), Addictions Program (SV, LZ, PS), and Health Systems & Health Equity Research (KM), Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry (PK, KM, PS), Department of Pharmacology and Toxicology (LZ), Dalla Lana School of Public Health (MC, PS), and Department of Family and Community Medicine (PS), University of Toronto, Toronto, Ontario, Canada; and Ontario Tobacco Research Unit (MC, PS), Toronto, Ontario, Canada.
• J Addict Med. 2015 May 1; 9 (3): 169-76.

ObjectiveTo compare the effectiveness and safety of varenicline with nicotine replacement therapy (NRT) among smokers with or without psychiatric disorders attending a storefront smoking cessation clinic in an urban addiction and mental health academic health science center.MethodsA retrospective chart review was conducted to compare treatment outcomes, demographics, and clinical characteristics for adult smokers prescribed varenicline (n = 98) or NRT (n = 98) between 2007 and 2010. Subjects were matched 1:1 on age, sex, and year of initial assessment.ResultsEnd-of-treatment quit rates were almost twice as high among those prescribed varenicline (33.7%) versus NRT (18.4%) (RR = 1.83, 95% CI = 1.11-3.03, P = 0.02). After adjusting for several baseline and treatment characteristics, varenicline was still significantly more effective than NRT (ARR = 1.71, 95% CI = 1.05-2.79, P = 0.03). History of psychiatric disorder (excluding substance use disorders) and treatment duration were also independent predictors of end-of-treatment quit rates. Nausea was more commonly reported among those using varenicline (13.3% vs 3.1%, P = 0.009). No single neuropsychiatric adverse effect significantly differed between groups; however, overall reporting of any neuropsychiatric effect was somewhat higher in the varenicline group (31.6% vs 20.4%, P = 0.07). There was one incident of suicidal ideation in each medication group.ConclusionsVarenicline seems to be more effective than NRT and as safe in real-world settings among patients with and without a history of psychiatric disorder.

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