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L. Elliot Hong, MD; Gunvant K. Thaker, MD; Robert P. McMahon, PhD; Ann Summerfelt, BS; Jill RachBeisel, MD; Rebecca L. Fuller, PhD; Ikwunga Wonodi, MD; Robert W. Buchanan, MD; Carol Myers, PhD; Stephen J. Heishman, PhD; Jeff Yang, BS; Adrienne Nye, BS

Arch Gen Psychiatry. 2011;68(12):1195-1206. doi:10.1001/archgenpsychiatry.2011.83

Context  The administration of nicotine transiently improves many neurobiological and cognitive functions in schizophrenia and schizoaffective disorder. It is not yet clear which nicotinic acetylcholine receptor (nAChR) subtype or subtypes are responsible for these seemingly pervasive nicotinic effects in schizophrenia and schizoaffective disorder.

Objective  Because α4β2 is a key nAChR subtype for nicotinic actions, we investigated the effect of varenicline tartrate, a relatively specific α4β2 partial agonist and antagonist, on key biomarkers that are associated with schizophrenia and are previously shown to be responsive to nicotinic challenge in humans.

Design  A double-blind, parallel, randomized, placebo-controlled trial of patients with schizophrenia or schizoaffective disorder to examine the effects of varenicline on biomarkers at 2 weeks (short-term treatment) and 8 weeks (long-term treatment), using a slow titration and moderate dosing strategy for retaining α4β2-specific effects while minimizing adverse effects.

Setting  Outpatient clinics.

Participants  A total of 69 smoking and nonsmoking patients; 64 patients completed week 2, and 59 patients completed week 8.

Intervention  Varenicline.

Main Outcome Measures  Prepulse inhibition, sensory gating, antisaccade, spatial working memory, eye tracking, processing speed, and sustained attention.

Results  A moderate dose of varenicline (1) significantly reduced the P50 sensory gating deficit in nonsmokers after long-term treatment (P = .006), (2) reduced startle reactivity (P = .02) regardless of baseline smoking status, and (3) improved executive function by reducing the antisaccadic error rate (P = .03) regardless of smoking status. A moderate dose of varenicline had no significant effect on spatial working memory, predictive and maintenance pursuit measures, processing speed, or sustained attention by Conners' Continuous Performance Test. Clinically, there was no evidence of exacerbation of psychiatric symptoms, psychosis, depression, or suicidality using a gradual titration (1-mg daily dose).

Conclusions  Moderate-dose treatment with varenicline has a unique treatment profile on core schizophrenia-related biomarkers. Further development is warranted for specific nAChR compounds and dosing and duration strategies to target subgroups of schizophrenic patients with specific biological deficits.

Trial Registration  clinicaltrials.gov Identifier: NCT00492349

Author Affiliations: Maryland Psychiatric Research Center (Drs Hong, Thaker, McMahon, Summerfelt, Wonodi, Buchanan, Yang, and Nye) and Department of Psychiatry (Drs Hong, Thaker, McMahon, Summerfelt, RachBeisel, Wonodi, Buchanan, Yang, and Nye), University of Maryland School of Medicine, and Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health (Drs Myers and Heishman), Baltimore, Maryland; and Department of Psychology, Catholic University of America, Washington, DC (Dr Fuller).

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