Toward Personalized Therapy for Smoking Cessation: A Randomized Placebo-controlled Trial of Bupropion.

Author(s): Patterson F, Schnoll R, Wileyto E, Pinto A, Epstein L, Shields P, Hawk L, Tyndale R, Benowitz N, Lerman C

Affiliation(s): 1Department of Psychiatry, Transdisciplinary Tobacco Use Research Center, Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA.

Publication date & source: 2008-04-02, Clin Pharmacol Ther., [Epub ahead of print]

Publication type:

We examined whether a pretreatment phenotypic marker of nicotine metabolism rate (NMR) predicts successful smoking cessation with bupropion. Smokers (N = 414) were tested for pretreatment NMR, based on the ratio of 3'-hydroxycotinine/cotinine derived during smoking, before entering a placebo-controlled randomized trial of bupropion plus counseling. At the end of the 10-week treatment phase, slow metabolizers (1st NMR quartile) had equivalent quit rates with placebo or bupropion (32%). Fast metabolizers (4th NMR quartile) had low quit rates with placebo (10%), and these were enhanced significantly by bupropion (34%). Smokers in the 2nd quartile (placebo: 25%, bupropion: 30%) and the 3rd quartile (placebo: 20%, bupropion: 30%) did not benefit significantly from bupropion. At the 6-month follow-up, the relationship between the NMR and quitting remained similar, but was no longer statistically significant. A pretreatment assessment of NMR may identify smokers who are most and least likely to benefit from treatment with bupropion for smoking cessation.Clinical Pharmacology & Therapeutics (2008) doi:10.1038/clpt.2008.57.