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DRUG, ALCOHOL, AND SUBSTANCE ABUSE

Outcomes of Bupropion Therapy for Smoking Cessation During Routine Clinical Use

Research Scientist, Research and Performance Support, Regina Qu'Appelle Health Region, Regina, Saskatchewan, Canada

James P McCormack, PharmD

Professor, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada

Mary HH Ensom, PharmD

Professor, Faculty of Pharmaceutical Sciences, University of British Columbia

Marc Levine, BSc(Pharm) PhD

Professor, Faculty of Pharmaceutical Sciences, University of British Columbia

Judith A Soon, PhD

Assistant Professor, Faculty of Pharmaceutical Sciences, University of British Columbia

David W Fielding, EdD

Professor, Faculty of Pharmaceutical Sciences, University of British Columbia

Reprints: Dr. Paluck, Research and Performance Support, Regina Qu'Appelle Health Region, 2180-23rd Ave., Regina, SK S4S 0A5, Canada, fax 306/766-5530, elan.paluck{at}rqhealth.ca

BACKGROUND: Knowledge pertaining to the effectiveness of smoking cessation treatments and patient characteristics that may affect success may enable smokers and clinicians to select individualized treatment for each patient and ultimately increase the success rate of smoking cessation in general.

OBJECTIVE: To evaluate the effectiveness of bupropion as a smoking cessation agent when used in routine clinical practice.

METHODS: This was a prospective, observational study with a one year follow-up period. Adult smokers presenting to community pharmacies in British Columbia, Canada, with an index prescription for bupropion for smoking cessation (N = 205) were eligible. The primary outcome was the biochemically validated 12 month point abstinence (PA) rate from smoking. Secondary outcomes included the frequency of adverse events, patterns of bupropion use in routine clinical practice, and possible predictors of bupropion effectiveness.

RESULTS: The validated 12 month PA rate was 21.0%. Of subjects who reported taking at least one dose of bupropion, 70.4% (126/179) experienced at least one adverse event and 29.6% (53/179) reported stopping the drug due to adverse effects. Greater length of time on bupropion (OR 0.98) and a lower cigarette pack-year history (OR 1.05) were associated with an increase in the odds of smoking cessation.

CONCLUSIONS: Subjects receiving bupropion in a real-life setting exhibited a similar abstinence rate at 12 months as has been observed in the active drug groups of placebo-controlled clinical trials. However, the patterns of use and discontinuation rate due to adverse events differed substantially from those observed in early efficacy studies.

Key Words: bupropion, smoking cessation

Published Online, January 24, 2006. www.theannals.com, DOI 10.1345/aph.1G324

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