Effectiveness of Bupropion

In this study, researchers aimed to determine the treatment intensity required to help a person successfully quit smoking. Since many smokers who are ready to quit enroll in smoking cessation programs like Free & Clear and express interest in pharmacotherapy, the researchers wanted to examine the optimal amount of behavioral treatment in combination with pharmacotherapy.

Therefore, they created four study groups with four different treatment intensities that varied on either the dose of buproprion hydrochloride sustained release (Zyban) or the type of smoking cessation program (Free & Clear or Zyban's own package of tailored materials).

Design

The researchers randomly assigned 1,524 adults smokers, who self-identified as ready to quit smoking, from Washington State to one of four groups as shown in Figure 1.0.

Figure 1.0

Findings

The primary outcome of interest was whether or not a person was successfully quit at 3 and 12 months following the smoker's target quit date.

At the 3 month assessment, there were significantly more nonsmokers in the F&C + 300mg Zyban group compared to the three other groups. The quit rate in the F&C + 300mg Zyban group was 35% at 3 months, whereas the lowest quit rate of 24.2% was found in the Zyban materials + 150mg Zyban group.

At 12 months, the 10.8% difference between the highest and lowest quit rates narrowed to a 9.6% difference; the F&C + 300mg Zyban group continued to have the highest quit rate at 12 months (33.2%) while the Zyban materials + 150mg Zyban group still had the lowest quit rate at 12 months (23.6%). The 3 and 12 month quit rates are shown below in Table 1.0.

 

Table 1.0 Percentage of nonsmokers in each group at 3 and 12 months

F&C + 150mg Zyban F&C + 300mg Zyban Zyban Materials + 150mg Zyban Zyban Materials + 300mg Zyban 3 Month 24.4 35 24.2 26.7 12 Month 31.4 33.2 23.6 25.7

 

 

For the groups with F&C as the behavioral intervention, the difference between the + 150mg Zyban and + 300mg Zyban groups seen at 3 months nearly disappears at the 12 month assessment (31.4% vs. 33.2%). For this reason, Free & Clear, Inc. has adopted the protocol of recommending a dose of 150mg (instead of 300mg) because the short-term of advantage of the higher Zyban dose fades at 12 months to achieve a statistically similar result as the lower 150mg dose.

In order to test the association between behavioral intervention and quitting while accounting for use of Zyban, the researchers collapsed the 4 groups into 2 groups so that they tested F&C (with Zyban doses collapsed) against Zyban materials (with Zyban doses collapsed). Consequently, they found nearly an 8% difference in quit rates between the Zyban materials + Zyban treatment (quit rate of 24.6%) and the F&C program + Zyban treatment (quit rate of 32.3%) at 12 months. In addition, the 12 month results showed participants using F&C plus Zyban were 20% more likely to quit smoking than those using Zyban's tailored materials plus Zyban.

Conclusion

In a study designed to determine the optimal combination of behavioral treatment and medication therapy, the researchers tested four combination cessation programs that varied on either the dose of Zyban or on the type of behavioral treatment. The findings show that Free & Clear is most effective when combined with Zyban and is more effective than a less intensive program using tailored mail materials.

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