[Abstinence rates with varenicline compared to bupropion and nicotine replacement therapy for quitting smoking in primary care]

Abstract

Objective: The objective of this study was to estimate the continuous abstinence rates of varenicline, bupropion and nicotine replacement therapy (NRT) in smoking cessation in 2 Primary Care (PC) External Support Units.

Design: Observational, multicentre, longitudinal study using a retrospective review of medical records.

Setting: Six Primary Care Centres.

Participants: Patients > 18 years, who began smoking cessation treatment between 1/01/2006 and 1/12/2008 with varenicline, bupropion or NRT were included in the analysis. CONTINUATION: Patient follow-up was conducted from time-baseline (day 1) and assessed at 6 and 12 months.

Main variables: comorbidities, effectiveness (continuous abstinence) and pharmacological tolerability.

Statistical analysis: logistic regression models and Kaplan-Maier survival curves; P<.05.

Results: A total of 957 smokers treated with NRT (53.0%), bupropion (25.1%) and varenicline (21.9%) were included in the analysis. Mean age: 47.6 (11.3) years; 58.6% men. 32.0% of smokers attended due to physical dependence. Average duration of smoking: 19.5 (6.7) years. At 6 months, 61.2% (95% CI: 54.6-67.8%) of participants in the varenicline group continuously abstained from smoking compared with 56.9% (95% CI: 50.6-63.2%) in the bupropion group, and 52.3% (95% CI: 48.0-56.6%) in the NRT group; P=.003. At 12 months, the rate of continuous abstinence was 57.4% (95% CI: 50.7-64.1%) in the varenicline group compared with 52.9% (95% CI: 46.6-59.2%) in the bupropion group and 47.1% (95% CI: 42.8-51.4%) in the NRT group; P=.002.

Conclusion: One year-follow up results suggest that varenicline is an appropriate alternative compared with bupropion and NRT on smoking cessation in the PC setting.

Esquema general del estudio: Estudio observacional realizado a partir de la revisión de los registros médicos de 2 unidades externas de apoyo a AP en pacientes > 18 años que iniciaron tratamiento de cesación del hábito tabáquico entre 2006 y 2008.

Figura 1

Curva de supervivencia: proporción de pacientes en abstinencia continua a los 12 meses de seguimiento según el tratamiento farmacológico. Abstinencia continua: definido como el número de pacientes que acudieron a las 2 unidades de deshabituación del tabaquismo con intención de recibir tratamiento y no fumaron ningún cigarrillo desde al menos 15 días después del día D hasta completar el periodo de estudio (SRNT Subcommittee on Biochemical Verification²²). Comparaciones entre los grupos terapéuticos (log rank): vareniclina-bupropión: ji cuadrado = 4,438; p = 0,035; vareniclina-TSN: ji cuadrado = 14,526; p < 0,001; bupropión-TSN: ji cuadrado = 4,125; p = 0,046. TSN: terapia de sustitución nicotínica.