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Previous Volume 340:685-691 March 4, 1999 Number 9 Next

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ABSTRACT

Background and Methods Use of nicotine-replacement therapies and the antidepressant bupropion helps people stop smoking. We conducted a double-blind, placebo-controlled comparison of sustained-release bupropion (244 subjects), a nicotine patch (244 subjects), bupropion and a nicotine patch (245 subjects), and placebo (160 subjects) for smoking cessation. Smokers with clinical depression were excluded. Treatment consisted of nine weeks of bupropion (150 mg a day for the first three days, and then 150 mg twice daily) or placebo, as well as eight weeks of nicotine-patch therapy (21 mg per day during weeks 2 through 7, 14 mg per day during week 8, and 7 mg per day during week 9) or placebo. The target day for quitting smoking was usually day 8.

Results The abstinence rates at 12 months were 15.6 percent in the placebo group, as compared with 16.4 percent in the nicotine-patch group, 30.3 percent in the bupropion group (P<0.001), and 35.5 percent in the group given bupropion and the nicotine patch (P<0.001). By week 7, subjects in the placebo group had gained an average of 2.1 kg, as compared with a gain of 1.6 kg in the nicotine-patch group, a gain of 1.7 kg in the bupropion group, and a gain of 1.1 kg in the combined-treatment group (P<0.05). Weight gain at seven weeks was significantly less in the combined-treatment group than in the bupropion group and the placebo group (P<0.05 for both comparisons). A total of 311 subjects (34.8 percent) discontinued one or both medications. Seventy-nine subjects stopped treatment because of adverse events: 6 in the placebo group (3.8 percent), 16 in the nicotine-patch group (6.6 percent), 29 in the bupropion group (11.9 percent), and 28 in the combined-treatment group (11.4 percent). The most common adverse events were insomnia and headache.

Conclusions Treatment with sustained-release bupropion alone or in combination with a nicotine patch resulted in significantly higher long-term rates of smoking cessation than use of either the nicotine patch alone or placebo. Abstinence rates were higher with combination therapy than with bupropion alone, but the difference was not statistically significant.

Source Information

From the Center for Tobacco Research and Intervention, University of Wisconsin Medical School, Madison (D.E.J., S.S.S., M.C.F., T.B.B.); the Arizona Program for Nicotine and Tobacco Research, University of Arizona, Tucson (S.J.L., M.L.M.); Los Angeles Clinical Trials, Los Angeles (M.A.N., K.D.); the Pulmonary and Critical Care Medicine Section, University of Nebraska Medical Center, Omaha (S.I.R., D.M.D.); and Glaxo Wellcome, Research Triangle Park, N.C. (J.A.J., A.R.H.).

Address reprint requests to Dr. Jorenby at 1300 University Ave., Rm. 7278 MSC, Madison, WI 53706.

Full Text of this Article

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Smoking Cessation
Hughes J. R., Jorenby D. E., Fiore M. C., Baker T. B.
Extract | Full Text  
N Engl J Med 1999; 341:610-611, Aug 19, 1999. Correspondence

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