Study Tests Combined Treatment for Smoking Cessation

A new study finds 12 weeks of combined treatment with bupropion and varenicline was more effective than varenicline alone at helping individuals in their attempts to quit smoking. A group of Mayo Clinic researchers compared the efficacy of the 2 treatment approaches in a phase III, double-blind clinical trial involving 506 adults treated for 12 weeks at 3 medical centers from 2009 to 2013. All study participants smoked at least 10 cigarettes per day at baseline, the study authors noted, adding that the 38 dropout rate was high, and combined therapy showed no significant advantage over varenicline alone when smoking abstinence was measured 1 year later. Patients were randomly assigned to receive for 12 weeks either up to 300 mg bupropion SR per day, plus up to 2 mg per day of varenicline, or varenicline alone. All participants attended 11 clinic visits, during which they received brief behavioral counseling, were assessed for smoking abstinence using exhaled-air carbon monoxide measurement, and completed assessments of tobacco craving and nicotine withdrawal. Patients also received a follow-up phone call on their target quit date, and 2 additional calls throughout 1 year of follow-up. While investigators described the 38 percent dropout rate as high, that rate did not differ drastically between the 2 groups. According to the authors, a total of 158 patients (63 percent) in the combination therapy group completed the study, as did 157 patients (61 percent) in the varenicline-only study. The primary endpoint for the study was the rate of smoking abstinence at week 12. The rate at that point was 53 percent among the combination therapy group, compared to a rate of 43 percent seen in participants treated with varenicline alone. Likewise, the rate of smoking abstinence at week 26 was significantly higher with combination therapy (36.6 percent) than with varenicline alone (27.6 percent). With regard to primary care physicians’ role in aiding and advising patients in their smoking cessation efforts, the study’s key takeaway is “that varenicline helps smokers quit,” says Jon O. Ebbert, MD, MSc, professor of medicine at the Mayo Clinic College of Medicine, a consultant with the Nicotine Dependence Center, and lead study author. He cautions, however, that “the combination of varenicline and buproprion is better than single drug therapy with varenicline for long-term smoking cessation” among heavier smokers—those who smoke 20 or more cigarettes per day—and more dependent smokers. “Consideration should be given to the use of this combination” in this group, says Ebbert. —Mark McGraw Reference Combination Varenicline and Bupropion SR for Tobacco-Dependence Treatment in Cigarette Smokers: A Randomized Trial. JAMA. 2014.