title: A 12-week double-blind, placebo-controlled study of bupropion sr added to high-dose dual nicotine replacement therapy for smoking cessation or reduction in schizophrenia.
abstract: The objective of this study was to examine whether there is a benefit of adding bupropion SR to high-dose combination nicotine replacement therapy (NRT) and weekly group cognitive behavioral therapy (CBT) for smoking reduction or cessation in schizophrenia. Fifty-one adult smokers with schizophrenia were randomly assigned to a 12-week trial of bupropion SR 300 mg/d or placebo added to transdermal nicotine patch, nicotine polacrilex gum, and CBT. The treatment goal was smoking cessation. The primary outcome measure was biochemically confirmed 7-day point-prevalence of 50% to 100% smoking reduction at week 12. Secondary outcomes were biochemically confirmed tobacco abstinence and change from baseline in expired air carbon monoxide (CO) and psychiatric symptoms. Subjects on bupropion + NRT had a greater rate of 50% to 100% smoking reduction at weeks 12 (60% vs. 31%; P = 0.036) and 24, a lower expired air CO in the treatment and follow-up periods, (F = 13.8; P < 0.001) and a greater continuous abstinence rate at week 8, before NRT taper, (52% vs. 19%; P = 0.014). However, relapse rates in subjects on bupropion + dual NRT were 31% during NRT taper (weeks 8-12) and 77% at the 12-month follow-up. Abstinence rates did not differ by treatment group at weeks 12 (36% vs. 19%), 24 (20% vs. 8%), or 52 (12% vs. 8%). Because abstinence rates were high during treatment with combination pharmacotherapy and relapse rates were very high during taper and after discontinuation of treatment, study of longer term treatment with combination pharmacotherapy and CBT for sustained abstinence is warranted in those who attain initial abstinence with this intervention.
authors.affiliation: Schizophrenia Program, Massachusetts General Hospital, Boston, MA 02144, USA. a_eden_evins@hms.harvard.edu
authors.forename: A Eden
authors.initials: AE
authors.lastname: Evins
authors.forename: Corinne
authors.initials: C
authors.lastname: Cather
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Culhane
authors.forename: Alan
authors.initials: A
authors.lastname: Birnbaum
authors.forename: Jonathan
authors.initials: J
authors.lastname: Horowitz
authors.forename: Elaine
authors.initials: E
authors.lastname: Hsieh
authors.forename: Oliver
authors.initials: O
authors.lastname: Freudenreich
authors.forename: David C
authors.initials: DC
authors.lastname: Henderson
authors.forename: David A
authors.initials: DA
authors.lastname: Schoenfeld
authors.forename: Nancy A
authors.initials: NA
authors.lastname: Rigotti
authors.forename: Donald C
authors.initials: DC
authors.lastname: Goff
mesh_terms: D000328:Adult; D018687:Antidepressive Agents, Second-Generation / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D016642:Bupropion / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D002248:Carbon Monoxide / Q000378:metabolism; D003692:Delayed-Action Preparations; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009538:Nicotine / Q000009:adverse effects / Q000627:therapeutic use*; D018722:Nicotinic Agonists / Q000009:adverse effects / Q000627:therapeutic use*; D011569:Psychiatric Status Rating Scales; D018401:Sample Size; D012559:Schizophrenia / Q000150:complications*; D012565:Schizophrenic Psychology; D016540:Smoking Cessation / Q000379:methods*
chemical_list: D018687:Antidepressive Agents, Second-Generation; D003692:Delayed-Action Preparations; D018722:Nicotinic Agonists; D016642:Bupropion; D009538:Nicotine; D002248:Carbon Monoxide