A Controlled
Trial of Sustained-Release Bupropion (Zyban) , a Nicotine Patch, or Both for Smoking Cessation
Each year, approximately
20 million of the 50 million smokers in the United States try to quit smoking, but only
about 6 percent of those who try succeed in quitting in the long term.
Nicotine-replacement therapies, such as the nicotine patch and nicotine gum, boost the
rates of smoking cessation by a factor of 1.4 to 2.6 in comparison with placebo
treatments, but 70 to 80 percent of smokers who use these therapies still start to smoke
again. Hurt and colleagues demonstrated that bupropion is an effective smoking-cessation
aid: at 12 months, the abstinence rates were 23 percent among subjects assigned to receive
300 mg of bupropion per day for 7 weeks and 12 percent among
subjects assigned to receive placebo. We compared bupropion, placebo, a nicotine
patch, and a combination of bupropion and the nicotine patch with regard to
efficacy.
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 (Zyban 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
(Habitrol, 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). N Engl J Med
1999;340:685-91 |