Effectiveness of bupropion sustained release for smoking cessation in a health care setting: a randomized trial.
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.


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


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


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


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


METHODS
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.
Center for Health Sciences, SRI International, 333 Ravenswood Ave, Menlo Park, CA 94025, USA. gary.swan@sri.com
Gary E
GE
Swan
Tim
T
McAfee
Susan J
SJ
Curry
Lisa M
LM
Jack
Harold
H
Javitz
Sara
S
Dacey
Katherine
K
Bergman
D000328:Adult; D016642:Bupropion / Q000008:administration & dosage* / Q000009:adverse effects; D003692:Delayed-Action Preparations; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016540:Smoking Cessation; D016896:Treatment Outcome
D003692:Delayed-Action Preparations; D016642:Bupropion