Quit Smoking American Style

Posting Date: 10/29/2003

Dr. Dean's Comment: These are impressive numbers but whether they can be duplicated out here in the real world remains to be seen. This study tried to duplicate the real world in that the study was done in actual practice setting. Either way a 25% to 33% abstinence rate at one year is very positive when you consider how dismal the numbers are for competing ways of quitting smoking. Talk with your doctor.

Effectiveness of Bupropion Sustained Release for Smoking Cessation in a Health Care Setting

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A Randomized Trial

Gary E. Swan, PhD; Tim McAfee, MD, MPH; Susan J. Curry, PhD; Lisa M. Jack, MA; Harold Javitz, PhD; Sara Dacey, MD; Katherine Bergman, RPh

Arch Intern Med. 2003;163:2337-2344.

Background The efficacy of bupropion hydrochloride sustained release (SR) (Zyban) for smoking cessation has been evaluated in clinical trials that included frequent in-person behavioral counseling, but not in actual practice settings.

Objective To determine the differential effectiveness of 2 doses of bupropion SR in combination with behavioral interventions of minimal to moderate intensity in an actual practice setting.

Design Open-label randomized trial, with 1 year of follow-up.

Setting A large health system (Group Health Cooperative) based in Seattle.

Participants Adult smokers (N = 1524) interested in quitting smoking.

Interventions Participants were randomly assigned to receive 1 of 4 combinations of bupropion SR (150 or 300 mg) and behavioral counseling (minimal or moderate intensity).

Main Outcome Measures The primary outcome measure was self-reported point-prevalence 7-day nonsmoking status at 3 and 12 months following the target quit date. Secondary outcomes included adverse and abstinence effects reported since beginning treatment with bupropion SR.

Results At 3 months, a significantly higher rate of nonsmoking was observed among those receiving the larger bupropion SR dose (P=.005). At 12 months, moderate intensity counseling was associated significantly with a higher rate of nonsmoking (P=.001). At 3 months, the higher dose was associated with a significantly increased frequency of self-reported symptoms such as difficulty sleeping (P=.02), difficulty concentrating (P=.02), shakiness/tremor (P=.002), and gastrointestinal problems (P=.005)and a decreased frequency of reported desire to smoke (P=.001).

Conclusions In this actual practice setting, the combination of bupropion SR and minimal or moderate counseling was associated with 1-year quit rates of 23.6% to 33.2%. This suggests that existing health care systems can substantially decrease tobacco use rates among their enrollees if they provide these modest interventions.

Arch Intern Med. 2003;163:2269.