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Predictors of 12-Month Outcome in Smokers Who Received Bupropion Sustained-Release for Smoking Cessation

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Abstract

Aim: To examine heterogeneity in outcome at 12 months following 8 weeks of treatment for smoking cessation with bupropion sustained-release (SR) 150 or 300 mg/day combined with behavioural counselling.

Design, setting, participants: Smokers were recruited from a large healthcare system and then randomized to receive either bupropion SR 150 mg/day (n = 763) or 300 mg/day (n = 761) taken for 8 weeks in combination with either proactive telephone counselling or a tailored mail approach.

Measurements and findings: A comprehensive set of relevant individual pre-treatment and treatment characteristics was included in the analysis. Smoking outcome at 12 months was defined as point-prevalence of any regular self-reported smoking within the 7 days prior to follow-up contact. Classification and regression tree analysis identified subgroups that varied with respect to likelihood of being nonsmokers at 12 months. Seven subgroups were identified among those receiving bupropion SR 150 mg/day (proportion of nonsmokers at 12 months ranged from 13.7% to 43.5%) and eight subgroups among those receiving bupropion SR 300 mg/day (proportion of nonsmokers at 12 months ranged from 9.6% to 51.7%). In the 150-mg/day group, those with the lowest rate reported no previous quit attempt of 1 month or more in duration while those with the highest rate all reported previous quit attempts of 1 month or longer. In the 300 mg/day group, those with the lowest rate had very high levels of dependence while those with the highest rate were more highly educated and smoked at a lower level. Across all subgroups, cost per 12-month quitter ranged from a low of $US302 to a high of $US2502.

Conclusions: These results indicate the presence of a substantial amount of variation in outcome following treatment with both dosages of bupropion SR, with substantial cost consequences. Variation in outcome could be reduced by providing treatments tailored to subgroups of individuals who are at exceptionally high risk for smoking following a quit attempt.

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Notes

  1. The use of trade names is for product identification purposes only and does not imply endorsement.

References

  1. Hurt RD, Sachs DP, Glover ED, et al. A comparison of sustained-release bupropion and placebo for smoking cessation. N Engl J Med 1997; 337: 1195–202

    Article  PubMed  CAS  Google Scholar 

  2. Jorenby DE, Leischow SJ, Nides MA, et al. A controlled trial of sustained-release bupropion, a nicotine patch, or both for smoking cessation. N Engl J Med 1999; 340: 685–91

    Article  PubMed  CAS  Google Scholar 

  3. Hays JT, Hurt RD, Rigotti NA, et al. Sustained-release bupropion for pharmacologic relapse prevention after smoking cessation, a randomized, controlled trial. Ann Intern Med 2001; 135: 423–33

    PubMed  CAS  Google Scholar 

  4. Ahluwalia JS, Dan, KS, et al. Smoking behaviors and regular source of health care among African Americans. Prev Med 2002; 34: 393–6

    Article  PubMed  Google Scholar 

  5. Hall SM, Humfleet GL, Reus VI, et al. Psychological intervention and antidepressant treatment in smoking cessation. Arch Gen Psychiat 2002; 59: 930–6

    Article  PubMed  CAS  Google Scholar 

  6. Tonnesen P, Tonstad S, Hjalmarson A, et al. A multicentre, randomized, double-blind, placebo-controlled, 1-year study of bupropion SR for smoking cessation. J Intern Med 2003; 254: 184–92

    Article  PubMed  CAS  Google Scholar 

  7. Tonstad S, Farsang C, Klaene G, et al. Bupropion SR for smoking cessation in smokers with cardiovascular disease: a multicentre, randomised study. Eur Heart J 2003; 24: 946–55

    Article  PubMed  CAS  Google Scholar 

  8. Jamerson BD, Nides M, Jorenby DE, et al. Late-term smoking cessation despite initial failure: an evaluation of bupropion sustained release, nicotine patch, combination therapy, and placebo. Clin Ther 2001; 23: 744–52

    Article  PubMed  CAS  Google Scholar 

  9. Cox LS, Patten CA, Niaura RS, et al. Efficacy of bupropion for relapse prevention in smokers with and without a past history of major depression. J Gen Intern Med 2004; 19: 828–34

    Article  PubMed  Google Scholar 

  10. Hayford KE, Patten CA, Rummans TA, et al. Efficacy of bupropion for smoking cessation in smokers with a former history of major depression or alcoholism. Br J Psychiat 1999; 174: 173–8

    Article  CAS  Google Scholar 

  11. Tashkin D, Kanner R, Bailey W, et al. Smoking cessation in patients with chronic obstructive pulmonary disease: a double-blind, placebo-controlled, randomised trial. Lancet 2001; 357: 1571–5

    Article  PubMed  CAS  Google Scholar 

  12. Gonzales DH, Nides MA, Ferry LH, et al. Bupropion SR as an aid to smoking cessation in smokers treated previously with bupropion: a randomized placebo-controlled study. Clin Pharmacol Ther 2001; 69: 438–44

    Article  PubMed  CAS  Google Scholar 

  13. Jack LM, Swan GE, Thompson E, et al. Bupropion SR and smoking cessation in the real world: methods for recruitment, screening, and exclusion for a field trial in a managed-care setting. Prev Med 2003; 36: 585–93

    Article  PubMed  Google Scholar 

  14. Swan GE, McAfee T, Curry S, et al. Effectiveness of bupropion SR for smoking cessation in a health care setting: a randomized trial. Arch Intern Med 2003; 163: 2337–44

    Article  PubMed  CAS  Google Scholar 

  15. Javitz HS, Swan GE, Zbikowski SM, et al. Cost-effectiveness of different combinations of bupropion SR dose and behavioral treatment for smoking cessation: a societal perspective. Am J Manag Care 2004; 10: 217–26

    PubMed  Google Scholar 

  16. Javitz HS, Swan GE, Zbikowski SM, et al. Return on investment of different combinations of bupropion SR dose and behavioral treatment for smoking cessation in a health care setting: an employer’s perspective. Value Health 2004; 7: 535–43

    Article  PubMed  Google Scholar 

  17. Haynes RB, Yao X, Degani A, et al. Interventions to enhance medication adherence. Cochrane Database Syst Rev 2005; (4): CD000011

  18. Krousel-Wood M, Hyre A, Muntner P, et al. Methods to improve medication adherence in patients with hypertension: current status and future directions. Curr Opin Cardiol 2005; 20: 296–300

    Article  PubMed  Google Scholar 

  19. Horne R. Compliance, adherence, and concordance: implications for asthma treatment. Chest 2006; 130(1 Suppl.): 65–72S

    Article  Google Scholar 

  20. Rief W, Avorn J, Barsky AJ. Medication-attributed adverse effects in placebo groups: implications for assessment of adverse effects. Arch Intern Med 2006; 166: 155–60

    Article  PubMed  Google Scholar 

  21. Evans WE. Pharmacogenomics: marshalling the human genome to individualise drug therapy. Gut 2003; 52Suppl. 2: iilO–8

    Google Scholar 

  22. Meibohm B, Beierle I, Derendorf H. How important are gender differences in pharmacokinetics? Clin Pharmacokinet 2002; 41: 329–42

    Article  PubMed  CAS  Google Scholar 

  23. Bernard S, Neville KA, Nguyen AT, et al. Interethnic differences in genetic polymorphisms of CYP2D6 in the U.S. population: clinical implications. Oncologist 2006; 11: 126–35

    CAS  Google Scholar 

  24. Peterson AM, McGhan WF. Pharmacoeconomic impact of non-compliance with statins. Pharmacoeconomics 2005; 23: 13–25

    Article  PubMed  Google Scholar 

  25. Brieman L, Friendman J, Oshen R, et al. Classification and regression trees. Belmont (CA): Wadsworth Publishing Company, 1984

    Google Scholar 

  26. Dusing, R. Adverse events, compliance, and changes in therapy. Curr Hyperten Rep 2001; 3: 488–92

    Article  CAS  Google Scholar 

  27. Demyttenaere K, Haddad P. Compliance with antidepressant therapy and antidepressant discontinuation symptoms. Acta Psychiat Scand Suppl 2000; 403: 50–6

    Article  CAS  Google Scholar 

  28. McDermott MM, Schmitt B, Wallner E. Impact of medication nonadherence on coronary heart disease outcomes: a critical review. Arch Intern Med 1997; 157: 1921–9

    Article  PubMed  CAS  Google Scholar 

  29. Alterman AI, Gariti P, Cook TG, et al. Nicodermal patch adherence and its correlates. Drug Alcohol Depend 1999; 53: 159–65

    Article  PubMed  CAS  Google Scholar 

  30. Hitsman B, Spring B, Borrelli B, et al. Influence of antidepressant pharmacotherapy on behavioral treatment adherence and smoking cessation outcome in a combined treatment involving fluoxetine. Exp Clin Psychopharmacol 2001; 9: 355–62

    Article  PubMed  CAS  Google Scholar 

  31. McAfee T, Sofian NS, Wilson J, et al. The role of tobacco intervention in population-based health care: a case study. Am J Prev Med 1998; 14: 46–52

    Article  PubMed  CAS  Google Scholar 

  32. Orleans CT, Schoenbach VJ, Wagner EH, et al. Self-help quit smoking interventions: effects of self-help materials, social support instructions, and telephone counselling. J Consult Clin Psychol 1991; 59: 439–48

    Article  PubMed  CAS  Google Scholar 

  33. Heatherton TF, Kozlowski LT, Frecker RC, et al. The Fager-strom test for nicotine dependence: a revision of the Fager-strom Tolerance Questionnaire. Br J Addict 1991; 86: 1119–27

    Article  PubMed  CAS  Google Scholar 

  34. Robins L, Heizer J. Diagnostic interview schedule: version III-A. St Louis (MO): Washington University School of Medicine, 1985

    Google Scholar 

  35. Hughes JR, Keely JP, Niaura RS, et al. Measures of abstinence in clinical trials: issues and recommendations [published erratum appears in Nicotine Tob Res 2003; 5: 603]. Nicotine Tob Res 2003; 5: 13–25

    PubMed  Google Scholar 

  36. Salford Systems [online]. Available from URL: http://www.salford-systems.com/whitepaper.html [Accessed 2002 Jan 1]

  37. Swan GE, Jack LM, Curry S, et al. Bupropion SR and counseling for smoking cessation in actual practice: predictors of outcome. Nictone Tab Res 2003; 5(6): 911–21

    Article  CAS  Google Scholar 

  38. Bhavnani SM, Drake JA, Forrest A, et al. A nationwide, multi-center, case-control study comparing risk factors, treatment, and outcome for vancomycin-resistant and -susceptible enterococcal bacteremia. Diag Microbiol Infect Dis 2000; 36: 145–58

    Article  CAS  Google Scholar 

  39. Germanson TP, Lanzino G, Kongable GL, et al. Risk classification after aneurysmal subarachnoid hemorrhage. Surg Neurol 1998; 49: 155–63

    Article  PubMed  CAS  Google Scholar 

  40. Kvasnicka HM, Thiele J, Schmitt-Graeff A, et al. Bone marrow features improve prognostic efficiency in multivariate risk classification of chronic-phase Ph(1) chronic myelogenous leukemia: a multicenter trial. J Clin Oncol 2001; 19: 2994–3009

    PubMed  CAS  Google Scholar 

  41. James KE, White RF, Kraemer HC. Repeated split sample validation to assess logistic regression and recursive partitioning: an application to the prediction of cognitive impairment. Statist Med 2005; 24: 3019–35

    Article  Google Scholar 

  42. Centers for Disease Control and Prevention. Cigarette smoking among adults: United States, 1999. MMWR Morb Mortal Wkly Rep 2001; 50: 869–73

    Google Scholar 

  43. Fiscella K, Franks P. Cost-effectivess of the transdermal nicotine patch as an adjunct to physicians’ smoking cessation counseling. JAMA 1996; 275: 1247–51

    Article  PubMed  CAS  Google Scholar 

  44. Stapleton JA, Lowin A, Russell MA. Prescription of transdermal nicotine patches for smoking cessation in general practice: evaluation of cost-effectiveness. Lancet 1999; 354: 210–5

    Article  PubMed  CAS  Google Scholar 

  45. Fiore MC, Bailey WC, Cohen SJ, et al. Treating tobacco use and dependence: clinical practice guidelines. Rockville (MD): United States Department of Health and Human Services, Public Health Service, 2000

  46. Augustson E, Marcus S. Use of the current population survey to characterize subpopulations of continued smokers: a national erspective on the ‘khardcore’ smoker phenomenon. Nicotine Tob Res 2004; 6: 621–9

    Article  PubMed  Google Scholar 

  47. Curry SJ, McBride CM. Relapse prevention for smoking cessation: review and evaluation of concepts and interventions. Ann Rev Pub Health 1994; 15: 345–66

    Article  CAS  Google Scholar 

  48. Dale LC, Olsen DA, Patten CA, et al. Predictors of smoking cessation among elderly smokers treated for nicotine dependence. Tob Control 1997; 6: 181–7

    Article  PubMed  CAS  Google Scholar 

  49. Ockene JK, Nutall R, Benfari RC, et al. A psychosocial model of smoking cessation and maintenance of cessation. Prev Med 1981; 10: 623–38

    Article  PubMed  CAS  Google Scholar 

  50. Ockene JK, Emmons KM, Mermelstein RJ, et al. Relapse and maintenance issues for smoking cessation. Health Psychol 2000; 19: 17–31

    Article  PubMed  CAS  Google Scholar 

  51. Swan GE, Jack LM, Ward MM. Subgroups of smokers with different success rates after use of transdermal nicotine. Addiction 1997; 92: 207–18

    Article  PubMed  CAS  Google Scholar 

  52. Patrick DL, Cheadle A, Thompson DC, et al. The validity of self-reported smoking: a review and meta-analysis. Am J Pub Health 1991; 84: 1086–93

    Article  Google Scholar 

  53. Benowitz NL, Jacob III P, Ahijevych KL, et al. Biochemical verification of tobacco use and cessation. Nicotine Tob Res 2002; 4: 149–59

    Article  Google Scholar 

  54. Glasgow RE, Mullooly JP, Vogt TM, et al. Biochemical validation of smoking status: pros, cons, and data from four low-intensity intervention trials. Addict Behav 1993; 18: 511–27

    Article  PubMed  CAS  Google Scholar 

  55. Durcan MJ, Deener G, White J, et al. The effect of bupropion sustained-release on cigarette craving after smoking cessation. Clin Ther 2002; 24: 540–51

    Article  PubMed  CAS  Google Scholar 

  56. Hurt RD, Wolter TD, Rigotti N, et al. Bupropion for pharmacologic relapse prevention to smoking: predictors of outcome. Addict Behav 2002; 27: 493–507

    Article  PubMed  Google Scholar 

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Acknowledgements

We would like to acknowledge the efforts of Sallie Dacey, MD, Katherine Bergman, RPh, Ella Thompson, Casey Luce, Rachel Grossman, Miriam Philby, Kymberli Hemberger and Gaye Courtney, as well as the consultative assistance of Michael Fiore, MD, and Nancy Rigotti, MD.

This research was supported by grant CA71358 from the National Cancer Institute. Bupropion sustained-release was provided by Group Health.

At the time this research was conducted, Free & Clear, Inc., was part of Group Health, and Dr McAfee, an investigator on this project, was an employee of Group Health. Dr McAfee is currently employed by Free & Clear, Inc., and has a financial interest in this company. The other authors have no conflicts of interest that are directly relevant to this study.

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Authors and Affiliations

  1. Center for Health Sciences, SRI International, 333 Ravenswood Ave, Menlo Park, California, 94025, USA

    Gary E. Swan, Lisa M. Jack & Harold S. Javitz

  2. Free & Clear, Inc., Seattle, Washington, USA

    Tim McAfee

  3. Center for Health Studies, Group Health, Seattle, Washington, USA

    Jennifer B. McClure

Authors
  1. Gary E. Swan
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  2. Lisa M. Jack
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  3. Harold S. Javitz
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  4. Tim McAfee
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  5. Jennifer B. McClure
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Correspondence to Gary E. Swan.

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Swan, G.E., Jack, L.M., Javitz, H.S. et al. Predictors of 12-Month Outcome in Smokers Who Received Bupropion Sustained-Release for Smoking Cessation. CNS Drugs 22, 239–256 (2008). https://doi.org/10.2165/00023210-200822030-00004

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