Clinical Question: Does the additio...

Clinical Question: Does the addition of bupropion to nicotine replacement and counseling improve cessation rates?

Setting: Outpatient (any)

cogitation Design: Randomized controlled trial (double-blinded)

Allocation: Uncertain

Synopsis: The investigators conducting this cogitation enrolled 209 men and 34 women who were receiving care at a Veterans Affairs medical center in the United States. These primarily unmarried, middle-aged, white smoker were recruited from hospital-based advertising, as well as from lists of patients who previously had participated in smoking-cessation clinical studies. Presumably, the patients in the latter collection had failed previous attempts at smoking cessation, although they may have taken up smoking to participate in the subject of attention (i.e., professional study participants).

The patients were randomized (allocation concealment uncertain) to receive placebo or bupropion in a dosage of 150 mg twice daily for seven weeks. Patients in one as well as the other groups received cognitive-behavior counseling for 30 to 60 minutes with five follow-up counseling sessions on telephone. They also received nicotine-replacement therapy using transdermal nicotine patches. Initially, quit rates were high (i.e., 81 percent at single week). However, the clinically relevant issue for smoking cessation is the quit rate at undivided year. In this study, biochemically confirmed quit rates at the same year were not statistically different between the brace groups: 19 percent in the bupropion-treated clump compared with 24 percent in the placebo-treated assemblage (P = not significant). These rises were in the intention-to-treat analysis. eventuates were higher in the patients who were compliant, still not different between the pair groups: 28 percent of compliant bupropion-treated patients and 22 percent of compliant placebo-treated patients. Although the subject of attention was large, as were the quit rates, the researchers did not provide a power calculation.

Bottom Line: The addition of bupropion does not further increase long-term quit rates in patients who receive nicotine replacement and cognitive-behavior counseling. Quit rates at common year were similarly high in the pair groups--22 and 28 percent (P = not significant). (Level of Evidence: 1b)

research Reference: Simon JA, et al. Bupropion for smoking cessation: a randomized trial. Arch Intern M September 13 2004;164:1797-803

Used with permission from Shaughnessy AF. Bupropion + nicotine replacement no better than replacement alone. Accessed online November 1 2004 at: http://www.InfoPOEMs.com.

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