title: Randomized trial of nicotine replacement therapy (NRT), bupropion and NRT plus bupropion for smoking cessation: effectiveness in clinical practice.
abstract: OBJECTIVE
  Bupropion was introduced for smoking cessation following a pivotal trial showing that it gave improved efficacy over the nicotine patch and also suggesting combination treatment was beneficial. We tested in clinical practice for an effectiveness difference between bupropion and nicotine replacement therapy (NRT), whether the combination improves effectiveness and whether either treatment might be more beneficial for certain subgroups of smokers.
  
  
  METHODS
  Open-label randomized controlled trial with 6-month follow-up.
  
  
  METHODS
  Four UK National Health Service (NHS) smoking cessation clinics.
  
  
  METHODS
  Smokers (n = 1071) received seven weekly behavioural support sessions and were randomized to an NRT product of their choice (n = 418), bupropion (n = 409) or NRT plus bupropion (n = 244).
  
  
  METHODS
  The primary outcome was self-reported cessation over 6 months, with biochemical verification at 1 and 6 months. Also measured were baseline demographics, health history, smoking characteristics and unwanted events during treatment.
  
  
  RESULTS
  Abstinence rates for bupropion (27.9%) and NRT (24.2%) were not significantly different (odds ratio = 1.21, 95% confidence interval = 0.883-1.67), and the combination rate (24.2%) was similar to that for either treatment alone. There was some evidence that the relative effectiveness of bupropion and NRT differed according to depression (χ(2) = 2.86, P = 0.091), with bupropion appearing more beneficial than NRT in those with a history of depression (29.8 versus 18.5%). Several unwanted symptoms were more common with bupropion.
  
  
  CONCLUSIONS
  There is no difference in smoking cessation effectiveness among bupropion, nicotine replacement therapy and their combination when used with behavioural support in clinical practice. There is some evidence that bupropion is more beneficial than nicotine replacement therapy for smokers with a history of depression.
authors.affiliation: Addictions Department, Institute of Psychiatry, Kings College London, London, UK; Cancer Department of Epidemiology and Public Health, Research UK Health Behaviour Research Centre, University College London, UK.
authors.forename: John
authors.initials: J
authors.lastname: Stapleton
authors.forename: Robert
authors.initials: R
authors.lastname: West
authors.forename: Peter
authors.initials: P
authors.lastname: Hajek
authors.forename: Jenny
authors.initials: J
authors.lastname: Wheeler
authors.forename: Eleni
authors.initials: E
authors.lastname: Vangeli
authors.forename: Zeinab
authors.initials: Z
authors.lastname: Abdi
authors.forename: Colin
authors.initials: C
authors.lastname: O'Gara
authors.forename: Hayden
authors.initials: H
authors.lastname: McRobbie
authors.forename: Kirsty
authors.initials: K
authors.lastname: Humphrey
authors.forename: Rachel
authors.initials: R
authors.lastname: Ali
authors.forename: John
authors.initials: J
authors.lastname: Strang
authors.forename: Gay
authors.initials: G
authors.lastname: Sutherland
mesh_terms: D000328:Adult; D001521:Behavior Therapy / Q000379:methods; D016642:Bupropion / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D018765:Dopamine Uptake Inhibitors / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D016540:Smoking Cessation / Q000379:methods*; D000074606:Smoking Prevention; D061485:Tobacco Use Cessation Devices; D016896:Treatment Outcome
chemical_list: D018765:Dopamine Uptake Inhibitors; D016642:Bupropion
keywords: Bupropion; NHS; NRT; combination treatment; depression; randomized trial; smoking cessation; varenicline