title: A real-life study of the effectiveness of different pharmacological approaches to the treatment of smoking cessation: re-discussing the predictors of success.
abstract: OBJECTIVE
  To evaluate the effectiveness of nicotine replacement therapy (NRT), bupropion, nortriptyline and combination therapy and describe factors associated with treatment success.
  
  
  BACKGROUND
  Clinical trials clearly demonstrate the efficacy of pharmacotherapy in smoking cessation. However, it is only after its use in real-life settings that clinical effectiveness and limitations of a treatment are fully known.
  
  
  METHODS
  Patients attended a four-session cognitive-behavioral program and received medicines free of charge. Abstinence from smoking was assessed at each visit.
  
  
  RESULTS
  A total of 868 smokers (68.8% women) were included. Their mean age was 49.6 years; the amount smoked was 25 cigarettes/day and the Fagerströ m Score was 6.6. Abstinence rates after 6 months and 1 year were 36.5% and 33.6%. In univariate analysis, male gender, age (>50), higher number of cigarettes smoked, cardiovascular comorbidities, longer interval from the last cigarette and combined treatment of nortriptyline plus NRT were predictive of abstinence, while neuropsychiatric comorbidities and the answer ''yes'' to the question ''Do you smoke more often during the first hours after waking'' were correlated with failure. In a multivariate model, predictors of abstinence were neuropsychiatric comorbidities, the answer ''yes'' to the question ''Do you smoke more often during the first hours after waking'' and combined treatment of nortriptyline plus NRT. Male gender and a longer period from the last cigarette were correlated with lower abstinence rate.
  
  
  CONCLUSIONS
  Satisfactory success rates were obtained in a teaching hospital. Factors such as age, daily cigarette consumption, number of pack-years and dependency score were not reliable markers of abstinence. The combination nortriptyline+NRT was independently associated with higher abstinence rates.
authors: Divisão de Pneumologia, Instituto do Coração, Hospital das Clínicas, Universidade de São Paulo, São Paulo, Brazil. gustavo.prado@incor.usp.br
authors: Gustavo Faibischew
authors: GF
authors: Prado
authors: Elisa Maria Siqueira
authors: EM
authors: Lombardi
authors: Marco Antônio
authors: MA
authors: Bussacos
authors: Frederico Leon
authors: FL
authors: Arrabal-Fernandes
authors: Mário
authors: M
authors: Terra-Filho
authors: Ubiratan de Paula
authors: Ude P
authors: Santos
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016642:Bupropion / Q000627:therapeutic use; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009538:Nicotine / Q000627:therapeutic use; D009661:Nortriptyline / Q000627:therapeutic use; D012189:Retrospective Studies; D012737:Sex Factors; D012907:Smoking / Q000188:drug therapy*; D016540:Smoking Cessation / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D016642:Bupropion; D009538:Nicotine; D009661:Nortriptyline