Therapeutics Initiative, University of British Columbia, Vancouver, BC, Canada.
Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada.
Addiction. 2020 Aug;115(8):1534-1546. doi: 10.1111/add.14951. Epub 2020 Feb 19.
Pharmacotherapies for smoking cessation are widely prescribed, despite substantial concerns being raised regarding the potential increased risk of cardiovascular (CV) and neuropsychiatric adverse events associated with these treatments. This study aimed to assess the relative CV and neuropsychiatric safety between varenicline and bupropion compared with nicotine replacement therapies (NRT) in adults without a recent history of depression.
Retrospective new-user cohort study.
US administrative data from 2006 to 2016 covering more than 100 million individuals.
Three study cohorts of new users, aged 18 years or older, limited to patients with no diagnosis or treatment for depression in the prior 12 months.
Propensity score adjusted log-binomial regression models. The primary outcome was a composite of hospitalized CV events. Secondary outcomes included a composite of hospitalized neuropsychiatric events and individual components of the primary outcome.
A total of 618 497 participants were included in our study cohorts. Compared with NRT (n = 32 237), varenicline (n = 454 698) was associated with a 20% lower 1-year CV risk [adjusted relative risk (RR) = 0.80, 95% confidence interval (CI) = 0.75-0.85], and bupropion (n = 131 562) was associated with a 25% lower 1-year CV risk (RR = 0.75, 95% CI = 0.69-0.81). Varenicline was associated with a 35% lower 1-year risk of neuropsychiatric hospitalization versus NRT (RR = 0.65, 95% CI = 0.59-0.72), and bupropion was associated with a 21% increase in 1-year risk of neuropsychiatric hospitalization (RR = 1.21, 95% CI = 1.09-1.35).
Varenicline compared with nicotine replacement therapy does not appear to be associated with an increased risk of cardiovascular or neuropsychiatric hospitalizations. Bupropion appears to be associated with a lower risk of cardiovascular hospitalization and a higher risk of neuropsychiatric hospitalization, compared with nicotine replacement therapy.
尽管人们对与这些治疗相关的心血管（CV）和神经精神不良事件的潜在风险增加提出了诸多担忧，但戒烟的药物疗法仍被广泛应用。本研究旨在评估与尼古丁替代疗法（NRT）相比，伐伦克林和安非他酮在近期无抑郁病史的成年人中的相对 CV 和神经精神安全性。
回顾性新用户队列研究。
2006 年至 2016 年美国覆盖超过 1000 万个人的行政数据。
三个新用户研究队列，年龄在 18 岁或以上，限于在过去 12 个月内没有抑郁诊断或治疗的患者。
倾向评分调整的对数二项式回归模型。主要结局是住院 CV 事件的综合指标。次要结局包括住院神经精神事件的综合指标和主要结局的各个组成部分。
我们的研究队列共纳入 618497 名参与者。与 NRT（n=32237）相比，伐伦克林（n=454698）在 1 年内的 CV 风险降低了 20%[调整后的相对风险（RR）=0.80，95%置信区间（CI）=0.75-0.85]，而安非他酮（n=131562）的 CV 风险降低了 25%（RR=0.75，95%CI=0.69-0.81）。与 NRT 相比，伐伦克林在 1 年内神经精神住院的风险降低了 35%（RR=0.65，95%CI=0.59-0.72），而安非他酮在 1 年内神经精神住院的风险增加了 21%（RR=1.21，95%CI=1.09-1.35）。
与尼古丁替代疗法相比，伐伦克林似乎不会增加心血管或神经精神住院的风险。与尼古丁替代疗法相比，安非他酮似乎与较低的心血管住院风险相关，与较高的神经精神住院风险相关。
