[The copyright line for this article was changed on 15 July 2014 after original online publication.]
Randomized trial of nicotine replacement therapy (NRT), bupropion and NRT plus bupropion for smoking cessation: effectiveness in clinical practice
Article first published online: 28 AUG 2013
© 2013 The Authors. Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction
This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
Volume 108, Issue 12, pages 2193–2201, December 2013
How to Cite
Stapleton, J., West, R., Hajek, P., Wheeler, J., Vangeli, E., Abdi, Z., O'Gara, C., McRobbie, H., Humphrey, K., Ali, R., Strang, J. and Sutherland, G. (2013), Randomized trial of nicotine replacement therapy (NRT), bupropion and NRT plus bupropion for smoking cessation: effectiveness in clinical practice. Addiction, 108: 2193–2201. doi: 10.1111/add.12304
- Issue published online: 15 NOV 2013
- Article first published online: 28 AUG 2013
- Accepted manuscript online: 17 JUL 2013 05:23AM EST
- Manuscript Revised: 22 AUG 2013
- Manuscript Accepted: 8 JUL 2013
- Manuscript Received: 3 JUL 2012
- combination treatment;
- randomized trial;
- smoking cessation;
Background and aims
Bupropion was introduced for smoking cessation following a pivotal trial showing that it gave improved efficacy over the nicotine patch and also suggesting combination treatment was beneficial. We tested in clinical practice for an effectiveness difference between bupropion and nicotine replacement therapy (NRT), whether the combination improves effectiveness and whether either treatment might be more beneficial for certain subgroups of smokers.
Open-label randomized controlled trial with 6-month follow-up.
Four UK National Health Service (NHS) smoking cessation clinics.
Smokers (n = 1071) received seven weekly behavioural support sessions and were randomized to an NRT product of their choice (n = 418), bupropion (n = 409) or NRT plus bupropion (n = 244).
The primary outcome was self-reported cessation over 6 months, with biochemical verification at 1 and 6 months. Also measured were baseline demographics, health history, smoking characteristics and unwanted events during treatment.
Abstinence rates for bupropion (27.9%) and NRT (24.2%) were not significantly different (odds ratio = 1.21, 95% confidence interval = 0.883–1.67), and the combination rate (24.2%) was similar to that for either treatment alone. There was some evidence that the relative effectiveness of bupropion and NRT differed according to depression (χ2 = 2.86, P = 0.091), with bupropion appearing more beneficial than NRT in those with a history of depression (29.8 versus 18.5%). Several unwanted symptoms were more common with bupropion.
There is no difference in smoking cessation effectiveness among bupropion, nicotine replacement therapy and their combination when used with behavioural support in clinical practice. There is some evidence that bupropion is more beneficial than nicotine replacement therapy for smokers with a history of depression.