title: Benefits of varenicline vs. bupropion for smoking cessation: a Bayesian analysis of the interaction of reward sensitivity and treatment.
abstract: BACKGROUND
  We have shown that differences in the level of neural activation to stimuli associated with smoking vs. natural rewards, a biomarker related to reward sensitivity, predict treatment outcome.
  
  
  OBJECTIVE
  This paper examined whether this biomarker moderates the impact of bupropion or varenicline on smoking cessation.
  
  
  METHODS
  Prior to treatment randomization, smokers (N = 180) in a placebo-controlled trial using bupropion and varenicline completed event-related potential recording (late positive potential, LPP) while viewing pleasant (P), cigarette (C)-related, and other pictures. We used Bayesian models to estimate the probability of interaction between treatment and the LPP for both efficacy and comparative effectiveness analyses.
  
  
  RESULTS
  Efficacy analysis showed that smokers with more neural activation to pleasant vs. cigarette-related stimuli (P > C) had a 98-99% chance of achieving greater abstinence than placebo (OR >1.00), using either medication from the end of treatment (EOT, primary outcome) through the 3-month follow-up. Relative to placebo, smokers with higher activation to cigarette-related vs. pleasant stimuli (C > P) had a 99% chance of increased benefit from varenicline at both time points (OR >1), but only 67 and 43% with bupropion at the EOT and 3-month follow-up, respectively. Comparative effectiveness analysis found that smokers with the C > P activation pattern had a 95-98% chance of benefit from varenicline vs. bupropion, while P > C smokers had a 50-58% chance of similar improvement with varenicline at the EOT and 3 months.
  
  
  CONCLUSIONS
  Varenicline appears to be the treatment of choice for smokers with the C > P pattern of neural activation, while for those showing P > C, varenicline and bupropion have similar efficacy.
authors.affiliation: Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Unit 1330, PO Box 301439, Houston, TX, 77230-1439, USA. pcinciri@mdanderson.org.
authors.forename: Paul M
authors.initials: PM
authors.lastname: Cinciripini
authors.affiliation: The University of Texas at Houston Health Sciences Center, Houston, TX, USA.
authors.forename: Charles E
authors.initials: CE
authors.lastname: Green
authors.affiliation: Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Unit 1330, PO Box 301439, Houston, TX, 77230-1439, USA.
authors.forename: Jason D
authors.initials: JD
authors.lastname: Robinson
authors.affiliation: Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Unit 1330, PO Box 301439, Houston, TX, 77230-1439, USA.
authors.forename: Maher
authors.initials: M
authors.lastname: Karam-Hage
authors.affiliation: Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Unit 1330, PO Box 301439, Houston, TX, 77230-1439, USA.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Engelmann
authors.affiliation: Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Unit 1330, PO Box 301439, Houston, TX, 77230-1439, USA.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Minnix
authors.affiliation: University of Utah, Salt Lake City, UT, USA.
authors.forename: David W
authors.initials: DW
authors.lastname: Wetter
authors.affiliation: University of Oklahoma Health Sciences Center and Oklahoma Tobacco Research Center, Oklahoma City, USA.
authors.forename: Francesco
authors.initials: F
authors.lastname: Versace
mesh_terms: D000328:Adult; D018687:Antidepressive Agents, Second-Generation / Q000627:therapeutic use; D001499:Bayes Theorem; D016642:Bupropion / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D018722:Nicotinic Agonists / Q000627:therapeutic use; D012201:Reward; D016540:Smoking Cessation / Q000379:methods* / Q000523:psychology; D000073869:Tobacco Smoking / Q000188:drug therapy*; D016896:Treatment Outcome; D000068580:Varenicline / Q000627:therapeutic use*
chemical_list: D018687:Antidepressive Agents, Second-Generation; D018722:Nicotinic Agonists; D016642:Bupropion; D000068580:Varenicline
keywords: Bayesian statistics; Bupropion; Comparative effectiveness; Smoking cessation; Varenicline