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Evidence summaries

Combination of Nicotine Replacement Therapy and Bupropion for Smoking Cessation

Bupropion appears not to enhance the effect of nicotine replacement therapy (NRT) compared with NRT alone. Level of evidence: "B"

Summary

A Cochrane review [Abstract] 1 included 6 studies with a total of 2695 subjects. Combining nicotine replacement therapy (NRT) (patch/gum/lozenge) with bupropion was more effective than bupropion alone (RR 1.24, 95% CI 1.06 to 1.45; 4 trials, n=1991). Combining nicotine patch with bupropion was more effective than placebo (RR 3.99, 95% CI 2.03 to 7.85; 1 trial, n=405). However combining nicotine lozenge with bupropion showed no significant effect (RR 1.54, 95% CI 0.81 to 2.90; 1 trial, n=405).

Another Cochrane review [Abstract] 2 included a network meta-analysis of 12 treatment-specific reviews (267 studies) involving 101804 participants. Bupropion was less effective than combination NRT (OR 0.68, CredI 0.5 to 0.91; indirect comparison). Bupropion was not shown to enhance the effect of NRT compared with NRT alone in 6 trials.

In an open-label RCT 3 1071 smokers received 7 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). The primary outcome was self-reported cessation over 6 months, with biochemical verification at 1 and 6 months. Abstinence rates for bupropion (27.9%) and NRT (24.2%) were not significantly different (odds ratio 1.21, 95% CI 0.883 to 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.

References

  • Stead LF, Perera R, Bullen C et al. Nicotine replacement therapy for smoking cessation. Cochrane Database Syst Rev 2012;(11):CD000146. [PubMed]
  • Cahill K, Stevens S, Perera R et al. Pharmacological interventions for smoking cessation: an overview and network meta-analysis. Cochrane Database Syst Rev 2013;(5):CD009329. [PubMed]
  • Stapleton J, West R, Hajek P et al. Randomized trial of nicotine replacement therapy (NRT), bupropion and NRT plus bupropion for smoking cessation: effectiveness in clinical practice. Addiction 2013;108(12):2193-201. [PubMed]

Primary/Secondary Keywords