Combination treatment with varenicline and bupropion in an adaptive smoking
cessation paradigm.
Author(s): Rose JE(1), Behm FM.
Affiliation(s): Author information:
(1)From the Department of Psychiatry and Behavioral Sciences, Duke University
Medical Center, Durham, N.C.
Publication date & source: 2014, Am J Psychiatry. , 171(11):1199-205
OBJECTIVE: The authors assessed the efficacy and safety of combination treatment
with varenicline and sustained-release bupropion for smokers who, based on an
assessment of initial smoking reduction prior to the quit date, were deemed
unlikely to achieve abstinence using nicotine patch treatment.
METHOD: In a randomized, double-blind, parallel-group adaptive treatment trial,
the authors identified 222 cigarette smokers who failed to show a reduction of
more than 50% in smoking after 1 week of nicotine patch treatment. Smokers were
randomly assigned to receive 12 weeks of varenicline plus bupropion or
varenicline plus placebo. The primary outcome measure was continuous smoking
abstinence at weeks 8-11 after the target quit date.
RESULTS: Both treatments were well tolerated. Participants who received the
combination treatment had a significantly higher abstinence rate than those who
received varenicline plus placebo (39.8% compared with 25.9%; odds ratio=1.89;
95% CI=1.07, 3.35). Combination treatment had a significantly greater effect on
abstinence rate in male smokers (odds ratio=4.26; 95% CI=1.73, 10.49) than in
female smokers (odds ratio=0.94; 95% CI=0.43, 2.05). It also had a significantly
greater effect in highly nicotine-dependent smokers (odds ratio=3.51, 95%
CI=1.64, 7.51) than in smokers with lower levels of dependence (odds ratio=0.71,
95% CI=0.28, 1.80).
CONCLUSIONS: Among smokers who did not show a sufficient initial response to
prequit nicotine patch treatment, combination treatment with varenicline and
bupropion proved more efficacious than varenicline alone for male smokers and for
smokers with a high degree of nicotine dependence.
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