Prescription medication boosts success in quitting smoking

Smokers taking the medication bupropion – with or without nicotine patches – were nearly twice as likely to have quit smoking one year later than those receiving patches alone or a placebo, according to a new national study published by UW Medical School researchers.

In the first direct comparison of the patch with bupropion, the medication both suppressed withdrawal symptoms and delayed weight gain, according to lead author Douglas Jorenby, a clinical psychologist with the school’s Center for Tobacco Research and Intervention.

The research appears in the March 4, 1999 New England Journal of Medicine. Nearly 900 smokers in four states participated in a nine-week quit attempt and one-year follow-up. Participants were randomly assigned to receive bupropion, nicotine patches, dual therapy (bupropion and patches) or a placebo. Abstinence, withdrawal severity, body weight and side effects were monitored. After one year, the two bupropion groups had the highest abstinence rates: 35.5 percent for the dual therapy group and 30.3 percent for the bupropion group, Jorenby said.

Abstinence rates were 16.4 percent among the patch-only group and 15.6 percent for the control group (those receiving placebos). Although dual therapy produced the highest abstinence rate, Jorenby said the improvement over bupropion alone wasn’t statistically significant. Researchers were impressed, however, with the way dual therapy controlled weight gain during the quit attempt.

All three treatment groups gained less weight than the control group, but the dual therapy group gained the least, he said.

Since many smokers stop trying to quit when they gain weight, reducing short-term weight gain could help more smokers quit, Jorenby said. All three treatments -bupropion, patches and dual therapy – were effective in reducing withdrawal symptoms, Jorenby said.

Insomnia was the most commonly reported side effect, occurring most often in the bupropion group. “Until recently, the nicotine patch was considered the first-line intervention for smoking cessation,” Jorenby said.”These findings indicate that bupropion should also be viewed in that class.”

The study results may have been influenced by an above-average commitment level among participants, who volunteered to take part, Jorenby said. Most had tried to quit smoking at least twice. More than one third had tried nicotine patches and about one-fourth had tried nicotine gum, Jorenby said.

All participants were individually counseled and tested weekly for smoking , factors which may have affected their behavior, he said. Researchers from the University of Wisconsin, the University of Arizona and the University of Nebraska, Los Angeles Clinical Trials and Glaxo Wellcome, Inc. participated in the study.

The research was supported by a grant from Glaxo Wellcome, which makes bupropion.