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Randomized Controlled Trial
. 2013 Dec;108(12):2193-201.
doi: 10.1111/add.12304. Epub 2013 Aug 28.

Randomized trial of nicotine replacement therapy (NRT), bupropion and NRT plus bupropion for smoking cessation: effectiveness in clinical practice

John Stapleton  1 , Robert West, Peter Hajek, Jenny Wheeler, Eleni Vangeli, Zeinab Abdi, Colin O'Gara, Hayden McRobbie, Kirsty Humphrey, Rachel Ali, John Strang, Gay Sutherland
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Free PMC article
Randomized Controlled Trial

Randomized trial of nicotine replacement therapy (NRT), bupropion and NRT plus bupropion for smoking cessation: effectiveness in clinical practice

John Stapleton et al. Addiction. 2013 Dec.
Free PMC article

Abstract

Background and aims: Bupropion was introduced for smoking cessation following a pivotal trial showing that it gave improved efficacy over the nicotine patch and also suggesting combination treatment was beneficial. We tested in clinical practice for an effectiveness difference between bupropion and nicotine replacement therapy (NRT), whether the combination improves effectiveness and whether either treatment might be more beneficial for certain subgroups of smokers.

Design: Open-label randomized controlled trial with 6-month follow-up.

Setting: Four UK National Health Service (NHS) smoking cessation clinics.

Participants: Smokers (n = 1071) received seven weekly behavioural support sessions and were randomized to an NRT product of their choice (n = 418), bupropion (n = 409) or NRT plus bupropion (n = 244).

Measures: The primary outcome was self-reported cessation over 6 months, with biochemical verification at 1 and 6 months. Also measured were baseline demographics, health history, smoking characteristics and unwanted events during treatment.

Findings: Abstinence rates for bupropion (27.9%) and NRT (24.2%) were not significantly different (odds ratio = 1.21, 95% confidence interval = 0.883-1.67), and the combination rate (24.2%) was similar to that for either treatment alone. There was some evidence that the relative effectiveness of bupropion and NRT differed according to depression (χ(2) = 2.86, P = 0.091), with bupropion appearing more beneficial than NRT in those with a history of depression (29.8 versus 18.5%). Several unwanted symptoms were more common with bupropion.

Conclusion: There is no difference in smoking cessation effectiveness among bupropion, nicotine replacement therapy and their combination when used with behavioural support in clinical practice. There is some evidence that bupropion is more beneficial than nicotine replacement therapy for smokers with a history of depression.

Keywords: Bupropion; NHS; NRT; combination treatment; depression; randomized trial; smoking cessation; varenicline.

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Figures

Figure 1
Figure 1
Flow of participants through the trial
Figure 2
Figure 2
Relation between treatment, history of depression and smoking cessation at 4 and 26 weeks after quit day. NRT = nicotine replacement therapy
See this image and copyright information in PMC

References

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