January 15, 2014
Combination Smoking-Cessation Therapy No More Effective After a Year

Rochester, MN—Using a combination therapy of varenicline and bupropion may show some effectiveness in the first weeks of smoking-cessation therapy but appeared to have little advantage over varenicline alone after 1 year, according to a new study.

The study, published recently in the Journal of the American Medical Association, was conducted by researchers at the Mayo Clinic in Rochester, Minnesota.

With smoking accounting for 62% of deaths among female smokers and 60% of deaths among male smokers, there is a need for greater investigation of innovative pharmacotherapeutic approaches to tobacco-dependence treatment, according to the article’s background.

“Exploration of combination therapy with existing drugs may provide the best opportunity to advance treatment in the absence of any new pharmacotherapies for tobacco dependence,” the authors note.

For the trial, 315 adults were randomized to 12 weeks of either varenicline and bupropion SR or varenicline and placebo. Follow-up continued for a year, with the primary outcomes—which were biochemically conformed—being abstinence rates at week 12, defined as prolonged abstinence, and 7-day point-prevalence abstinence.

The study found that combination therapy was associated with significantly higher prolonged smoking abstinence rates at 12 weeks (53.0% vs. 43.2%) and 26 weeks (36.6% vs. 27.6%) compared with varenicline monotherapy.

At 52 weeks, however, no statistically significant differences were observed in prolonged smoking abstinence rates between the two groups, 30.9% vs. 24.5%.
The combination therapy produced more anxiety (7.2% vs. 3.1%) and depressive symptoms (3.6% vs. 0.8%) than varenicline alone.

“Among cigarette smokers, combined use of varenicline and bupropion, compared with varenicline alone, resulted in an increase in prolonged abstinence but not 7-day point-prevalence at 12 and 26 weeks; neither outcome was significantly different at 52 weeks. Further research is required to determine the role of combination treatment in smoking cessation,” the authors conclude.

Whatever the benefits of smoking-cessation therapy, tobacco control in the United States has been highly effective, according to another study in the same issue of JAMA. A study led by Yale University researchers estimates that tobacco control in the U.S. since 1964 has been associated with the avoidance of an estimated 8 million premature smoking-attributable deaths. Beneficiaries of the avoided early deaths gained, on average, nearly two decades of life, according to the report.

“Despite the success of tobacco control efforts in reducing premature deaths in the United States, smoking remains a significant public health problem,” the authors write. “Today, a half century after the surgeon general's first pronouncement on the toll that smoking exacts from U.S. society, nearly a fifth of U.S. adults continue to smoke, and smoking continues to claim hundreds of thousands of lives annually. No other behavior comes close to contributing so heavily to the nation's mortality burden. Tobacco control has been a great public health success story but requires continued efforts to eliminate tobacco-related morbidity and mortality.”

U.S. Pharmacist Social Connect