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Benefits of varenicline vs. bupropion for smoking cessation: a Bayesian analysis of the interaction of reward sensitivity and treatment

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Abstract

Rationale

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.

Objectives

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.

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Acknowledgements

The authors wish to thank Krystle Bartley, Dr. Victoria L. Brown, Jennifer Canul, Janeene Frerking, Christine Jeria, Paul Longoria, Samuel W. Miller, Kevin Mulpur, Cissette Muster, Tiffany Rattler, and Susana Torres for their help in the data collection. This study was conducted in accordance with the ethical standards of the University of Texas MD Anderson Cancer Center and applicable US Department of Health and Human Services regulations.

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Authors and Affiliations

  1. Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Unit 1330, PO Box 301439, Houston, TX, 77230-1439, USA

    Paul M. Cinciripini, Jason D. Robinson, Maher Karam-Hage, Jeffrey M. Engelmann & Jennifer A. Minnix

  2. The University of Texas at Houston Health Sciences Center, Houston, TX, USA

    Charles E. Green

  3. University of Utah, Salt Lake City, UT, USA

    David W. Wetter

  4. University of Oklahoma Health Sciences Center and Oklahoma Tobacco Research Center, Oklahoma City, USA

    Francesco Versace

Authors
  1. Paul M. Cinciripini
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  2. Charles E. Green
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  3. Jason D. Robinson
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  4. Maher Karam-Hage
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  5. Jeffrey M. Engelmann
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  6. Jennifer A. Minnix
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  7. David W. Wetter
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  8. Francesco Versace
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Corresponding author

Correspondence to Paul M. Cinciripini.

Ethics declarations

The University of Texas MD Anderson Cancer Center Institutional Review Board approved the protocol and informed consent.

Funding

Support for this research was provided by grants from the National Institute on Drug Abuse (grant number R01DA017073) to Paul M. Cinciripini and the Cancer Center Support Grant from the National Cancer Institute (grant number P50CA70907) to MD Anderson Cancer Center. Pfizer provided the varenicline and matching placebo.

Conflict of interest

Dr. Cinciripini served on the scientific advisory board of Pfizer Pharmaceuticals and conducted educational talks sponsored by Pfizer on smoking cessation (2006–2008) and has received grant support from Pfizer. The other authors declare that they have no conflict of interest.

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Cinciripini, P.M., Green, C.E., Robinson, J.D. et al. Benefits of varenicline vs. bupropion for smoking cessation: a Bayesian analysis of the interaction of reward sensitivity and treatment. Psychopharmacology 234, 1769–1779 (2017). https://doi.org/10.1007/s00213-017-4580-2

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