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| |  ACCP: Nicotine-Free Smoking Cessation Pill, Zyban (Bupropion), Effective For All Categories of Smokers NORTHBROOK, IL -- May 14, 2001 -- A nicotine-free pill was shown to be effective in helping cigarette smokers with various characteristics break their smoking habit, according to a new report published in the May issue of Chest, the peer-reviewed journal of the American College of Chest Physicians (ACCP). The report also noted that when people were able to refrain from smoking at the end of the first 14 days, whether they were on the pill or not, their chances of continued success in their quit attempts were much greater. The pill - a sustained release (SR) form of bupropion-was used by researchers at three sites involving 615 healthy men and women who were smoking at least 15 cigarettes a day and were motivated to stop smoking. Investigators hypothesized that if it were possible to identify smokers who would be more likely to succeed or fail with bupropion therapy, treatment decisions could be made that might increase the patient’s likelihood of achieving abstinence. They said "increasing the intensity of the behavioral treatment, adding nicotine replacement therapy to bupropion therapy, and considering residential treatment for smokers with severe nicotine dependence are all options that could be considered if accurate predictors of abstinence were available." Study participants were randomly assigned to receive bupropion SR treatment at a dosage of 100, 150, or 300 mg/d or placebo for seven weeks, and were observed for 52 weeks. Demographic information, data on smoking history, smoking rates, and symptoms of nicotine withdrawal during the medication phase was collected, and several questionnaires were administered. Researchers found that higher doses of bupropion, lower number of cigarettes per day that individual participants had previously smoked, the length of abstinence from smoking in previous quit attempts, and male gender were strong predictors of success in the cessation attempt. Other variables that were found to be predictive of greater cessation rates included abstinence from smoking during the second week following the target quit date, older age, lower scores on the Fagerström Tolerance Questionnaire (FTQ), absence of other smokers in the household, and greater number of previous stop attempts. Lowell C. Dale, M.D., of the Nicotine Research Center at the Mayo Clinic and Mayo Foundation in Rochester said that 70 percent of those not smoking by the end of the second week were still not smoking at the end of the medication phase five weeks later, whether they were using bupropion or not. Of those who were smoking at the two-week point, Dr. Dale said, only 5-18 percent were not smoking by the end of the medication phase. Speaking on behalf of his colleagues, Dr. Dale said: "Interestingly, male gender predicted greater abstinence rates than did female gender." While some studies have not found a gender difference in ability to stop smoking, other studies, he said, have noted that women have more trouble quitting than men. "This has been attributed to women’s greater concerns about weight gain when they stop smoking and to this fear of weight gain as a more frequently reported precipitant for relapse compared to men," he said. Dr. Dale added: "Women also have higher rates of depression than men and are more likely to use smoking as a means of managing negative affect." Dr. Dale also reported that the findings of this study have been used to construct an abstinence index involving such variables as male gender, previous abstinence from smoking, and average rate of cigarettes per day. This index could be used to determine which participants would have likely success with bupropion therapy and a brief behavioral intervention, and which would need more intensive treatment. In summary, Dr. Dale said, "this analysis identified the following four important concepts that clinicians may find valuable in treating their patients who smoke: 1) Bupropion therapy is effective for a wide range of smokers. We did not identify any characteristics of smokers that significantly influenced the efficacy of bupropion therapy. 2) The following characteristics were identified that predicted greater rates of abstinence from smoking that were independent of bupropion use: male gender; length of abstinence from smoking with previous stop attempts; and lower number of cigarettes smoked per day. 3) Smoking status during the first two weeks after the target quit date is an important predictor of long-term abstinence. 4) An abstinence index constructed from this analysis is predictive of success in stopping smoking." Bupropion SR is available as a prescription drug called Zyban, manufactured by Glaxo-SmithKline, which supported this study with a grant. SOURCE: American College of Chest Physicians Related Links: Zyban (bupropion) and GlaxoSmithKline.
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