Bupropion To Prevent Relapse in People Who Quit Cigarette Smoking

Summaries for Patients are a service provided by Annals to help patients better understand the complicated and often mystifying language of modern medicine.

Summaries for Patients are presented for informational purposes only. These summaries are not a substitute for advice from your own medical provider. If you have questions about this material, or need medical advice about your own health or situation, please contact your physician. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the American College of Physicians-American Society of Internal Medicine.

The summary below is from the full report titled "Sustained-Release Bupropion for Pharmacologic Relapse Prevention after Smoking Cessation. A Randomized, Controlled Trial." It is in the 18 September 2001 issue of Annals of Internal Medicine (volume 135, pages 423-433). The authors are JT Hays, RD Hurt, NA Rigotti, R Niaura, D Gonzales, MJ Durcan, DPL Sachs, TD Wolter, AS Buist, JA Johnston, and JD White.

What is the problem and what is known about it so far?

The difficult task of quitting cigarette smoking has been made somewhat easier by the use of nicotine replacement therapy and non-nicotine medications, such as bupropion. Even so, 70% to 80% of people who are able to stop smoking begin smoking again within 6 to 12 months. Although bupropion has been shown to be effective for short-term avoidance of smoking, no one knows if prolonged treatment can prevent a smoking relapse.

Why did the researchers do this particular study?

To find out if smoking relapses can be prevented by prolonged treatment with bupropion.

Who was studied?

784 healthy smokers who were motivated to quit were enrolled at five major medical centers in the United States.

How was the study done?

All participants were given sustained-release bupropion (but not nicotine replacement) for 7 weeks. Participants who reported complete avoidance of smoking during the 7th week and who showed no bodily evidence of nicotine were randomly assigned to one of two treatment groups: For the next 45 weeks, half of the participants continued to receive bupropion while the other half received an identical-appearing placebo pill. Neither the participants nor the evaluators were told which type of pill each participant was receiving. At monthly meetings, participants were questioned to see if they had remained free of cigarette smoking. To confirm reports of smoking abstinence, testing for evidence of nicotine in the body was done in participants who said that they had been free of cigarette smoking. After 1 year, treatment was stopped in both the bupropion and the placebo groups, but follow-up to detect smoking relapse continued for another year to evaluate the long-term effect of having received bupropion. Weight change over time was also recorded.

What did the researchers find?

Of the 784 participants, 461 had quit smoking by the 7th week and 429 were assigned to receive bupropion or placebo for the next 45 weeks. After 45 weeks, 55.1% of the bupropion group had abstained from smoking versus 42.3% of the placebo group. The relapse rate in the two groups remained different for up to 6 months after medication was stopped. However, 1 year after medication was stopped, the difference had disappeared (41.6% of the bupropion group and 40.0% of the placebo group were free of smoking). Weight gain was greater in the placebo group, and this difference remained until the end of the study. Side effects were as common in placebo recipients as in bupropion recipients.

What were the limitations of the study?

The research participants may not be representative of all smokers, and therefore results may differ in the general population. Many participants dropped out before the end of the study.

What are the implications of the study?

Bupropion seems effective in increasing the quit rate among cigarette smokers. As long as bupropion is continued, the smoking relapse rate remains lower than in persons treated with placebo, but the effect does not continue for very long after the medication is stopped. Bupropion appears to limit the weight gain associated with quitting cigarette smoking.