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More on Bupropion for Smoking Cessation

In a recent study, a 7-week course of sustained-release bupropion doubled the rate of abstinence from smoking at 1 year -- 23 percent with bupropion vs. 12 percent with placebo (JW Nov 15 1997, p. 173, accession number 971031001, and N Engl J Med 1997; 337:1195). In 2 new reports, researchers sponsored by the maker of sustained-release bupropion add new insights.

In the first report, researchers reanalyzed data from the original study to determine predictors of smoking abstinence at 7 weeks. In a multivariate analysis, 4 predictors emerged: higher daily bupropion dose (150 or 300 mg vs. 100 mg); male sex; longest previous abstinent period, shorter than 24 hours or longer than 4 weeks; and fewer cigarettes per day. For example, a pack-a-day male smoker with a previous 6-month period of abstinence had roughly a 50 percent probability of abstinence at 7 weeks with bupropion, compared with about a 25 percent probability for a female smoker with a longest previous abstinence period of 1 week.

The second study, a randomized trial, involved smokers with mild or moderate chronic obstructive pulmonary disease (COPD); participants received 300 mg of bupropion or placebo daily for 12 weeks. Rates of continuous abstinence were significantly higher with bupropion than with placebo at 7 weeks (28 percent vs. 16 percent) and at 26 weeks (16 percent vs. 9 percent).

Comment: Readers can use tables in the Chest article to help identify those patients most likely to quit with bupropion. A shortcoming of that analysis, however, is the use of 7 weeks (instead of 6 or 12 months) as the endpoint. The Lancet study results show that bupropion can modestly enhance quit rates among COPD patients. Unfortunately, long-term absolute response rates don't seem to be very high in any population of heavy smokers.

— AS Brett

Published in Journal Watch General Medicine June 12, 2001

Citation(s):

Dale LC et al. Bupropion for smoking cessation: Predictors of successful outcome. Chest 2001 May 119 1357-1364.

• Original article (Subscription may be required)
• Medline abstract (Free)

Tashkin DP et al. Smoking cessation in patients with chronic obstructive pulmonary disease: A double-blind, placebo-controlled, randomised trial. Lancet 2001 May 19 357 1571-1575.

• Medline abstract (Free)