Elsevier

Addictive Behaviors

Volume 27, Issue 4, July–August 2002, Pages 493-507
Addictive Behaviors

Bupropion for pharmacologic relapse prevention to smoking: Predictors of outcome

https://doi.org/10.1016/S0306-4603(01)00188-5Get rights and content

Abstract

The aim of this study was to identify predictors of successful relapse prevention in smokers receiving long-term sustained-release bupropion. Smokers (N=784) who were interested in stopping smoking were enrolled in a 7-week, open-label bupropion phase. Abstinent subjects at the end of treatment and eligible to proceed (N=429) were randomized to active bupropion or placebo through Week 52 and then followed for an additional year. The best overall predictor of less relapse to smoking was assignment to active bupropion. In aggregate, the results indicate that bupropion can be prescribed to diverse populations of smokers with expected comparable results. There was a medication effect that was independent of any predictor except older age and those who gained no or minimal weight during the open-label phase. Predictors of successful relapse prevention included lower baseline smoking rates, a Fagerström Tolerance Questionnaire score of <6, and initiation of smoking at an older age. These data should encourage others to perform similar pharmacologic relapse prevention studies with this or other pharmacotherapies.

Section snippets

Background

Despite recent advances in the treatment of nicotine dependence, relapse to smoking after initial successful abstinence remains a major treatment issue. This occurs despite an increasing array of effective pharmacotherapies, both nicotine and nonnicotine, that have been shown to help smokers to stop smoking Hughes et al., 1999, The Tobacco Use and Dependence Clinical Practice Guideline Panel, Staff and Consortium Representatives, 2000. Until recently, long-term pharmacotherapy had not been

Methods

The subjects for this analysis were part of a previously reported randomized, double-blind, placebo-controlled trial using sustained-release bupropion for relapse prevention (Hays et al., in press). The methodology for the study is detailed in that report. The study was performed at five sites (Mayo Clinic, Rochester, MN; the Palo Alto Center for Pulmonary Disease Prevention, Palo Alto, CA; Brown University, Providence, RI; Oregon Health Sciences University, Portland, OR; and Harvard Medical

Statistical analysis

We utilized both univariate and multivariate analyses in a similar fashion to our previous work Dale et al., 1997, Dale et al., 2001 because each type of analysis gives a different perspective of the data. Initially, a univariate analysis was used to determine, on an individual basis, which factors were associated with smoking abstinence. However, since factors identified univariately may be associated (correlated) with other factors (i.e., no adjustment is made for other factors), we also

Results

This study included 784 cigarette smokers who received 7 weeks of open-label, sustained-release bupropion 300 mg/day. The 1-week, biochemically confirmed abstinence rate during the final week of open-label medication was 58.8% (461/784). Among the 461 subjects biochemically confirmed abstinent from smoking at the end of the open-label phase (Week 7) and eligible, 429 were randomized to an additional 45 weeks of treatment with either placebo (N=215) or bupropion 300 mg/day (N=214). The percent

Discussion

In this paper, we report the first predictors analysis of the first pharmacotherapy trial for relapse prevention using sustained-release bupropion. When taking the findings from this study in aggregate, it is apparent that bupropion can be prescribed to diverse populations of smokers with expected comparable results. There were, however, some factors that seem to be predictive of successful relapse prevention. At Week 52, we found that there was a medication effect that was independent of any

Acknowledgements

This study was supported in part by a grant from Glaxo Wellcome, Research Triangle Park, NC. Special thanks to Rhonda Baumberger and Debi Judy for manuscript preparation.

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