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Randomized Controlled Trial
. 2017 Jun;234(11):1769-1779.
doi: 10.1007/s00213-017-4580-2. Epub 2017 Mar 8.

Benefits of varenicline vs. bupropion for smoking cessation: a Bayesian analysis of the interaction of reward sensitivity and treatment

Paul M Cinciripini  1 , Charles E Green  2 , Jason D Robinson  3 , Maher Karam-Hage  3 , Jeffrey M Engelmann  3 , Jennifer A Minnix  3 , David W Wetter  4 , Francesco Versace  5
Affiliations
Randomized Controlled Trial

Benefits of varenicline vs. bupropion for smoking cessation: a Bayesian analysis of the interaction of reward sensitivity and treatment

Paul M Cinciripini et al. Psychopharmacology (Berl). 2017 Jun.

Abstract

Rationale: We have shown that differences in the level of neural activation to stimuli associated with smoking vs. natural rewards, a biomarker related to reward sensitivity, predict treatment outcome.

Objectives: This paper examined whether this biomarker moderates the impact of bupropion or varenicline on smoking cessation.

Methods: Prior to treatment randomization, smokers (N = 180) in a placebo-controlled trial using bupropion and varenicline completed event-related potential recording (late positive potential, LPP) while viewing pleasant (P), cigarette (C)-related, and other pictures. We used Bayesian models to estimate the probability of interaction between treatment and the LPP for both efficacy and comparative effectiveness analyses.

Results: Efficacy analysis showed that smokers with more neural activation to pleasant vs. cigarette-related stimuli (P > C) had a 98-99% chance of achieving greater abstinence than placebo (OR >1.00), using either medication from the end of treatment (EOT, primary outcome) through the 3-month follow-up. Relative to placebo, smokers with higher activation to cigarette-related vs. pleasant stimuli (C > P) had a 99% chance of increased benefit from varenicline at both time points (OR >1), but only 67 and 43% with bupropion at the EOT and 3-month follow-up, respectively. Comparative effectiveness analysis found that smokers with the C > P activation pattern had a 95-98% chance of benefit from varenicline vs. bupropion, while P > C smokers had a 50-58% chance of similar improvement with varenicline at the EOT and 3 months.

Conclusions: Varenicline appears to be the treatment of choice for smokers with the C > P pattern of neural activation, while for those showing P > C, varenicline and bupropion have similar efficacy.

Keywords: Bayesian statistics; Bupropion; Comparative effectiveness; Smoking cessation; Varenicline.

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Conflict of interest statement

Conflict of interest Dr. Cinciripini served on the scientific advisory board of Pfizer Pharmaceuticals and conducted educational talks sponsored by Pfizer on smoking cessation (2006–2008) and has received grant support from Pfizer. The other authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Prolonged abstinence at the end of treatment (EOT) and at the 3- and 6-month follow-ups by the LPP group (P > C/C > P) and treatment [placebo (PLA), bupropion (BUP), varenicline (VAR)] for a P > C and b C > P
See this image and copyright information in PMC

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