Combination Treatment With Varenicline and Bupropion in an Adaptive Smoking Cessation Paradigm
Abstract
OBJECTIVE The authors assessed the efficacy and safety of combination treatment with
varenicline and sustained-release bupropion for smokers who, based on an assessment
of initial smoking reduction prior to the quit date, were deemed unlikely to achieve
abstinence using nicotine patch treatment. METHOD In a randomized, double-blind, parallel-group
adaptive treatment trial, the authors identified 222 cigarette smokers who failed
to show a reduction of more than 50% in smoking after 1 week of nicotine patch treatment.
Smokers were randomly assigned to receive 12 weeks of varenicline plus bupropion or
varenicline plus placebo. The primary outcome measure was continuous smoking abstinence
at weeks 8-11 after the target quit date. RESULTS Both treatments were well tolerated.
Participants who received the combination treatment had a significantly higher abstinence
rate than those who received varenicline plus placebo (39.8% compared with 25.9%;
odds ratio=1.89; 95% CI=1.07, 3.35). Combination treatment had a significantly greater
effect on abstinence rate in male smokers (odds ratio=4.26; 95% CI=1.73, 10.49) than
in female smokers (odds ratio=0.94; 95% CI=0.43, 2.05). It also had a significantly
greater effect in highly nicotine-dependent smokers (odds ratio=3.51, 95% CI=1.64,
7.51) than in smokers with lower levels of dependence (odds ratio=0.71, 95% CI=0.28,
1.80). CONCLUSIONS Among smokers who did not show a sufficient initial response to
prequit nicotine patch treatment, combination treatment with varenicline and bupropion
proved more efficacious than varenicline alone for male smokers and for smokers with
a high degree of nicotine dependence.
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https://hdl.handle.net/10161/9020Published Version (Please cite this version)
10.1176/appi.ajp.2014Publication Info
Rose, JE; & Behm, FM (2014). Combination Treatment With Varenicline and Bupropion in an Adaptive Smoking Cessation
Paradigm. American Journal of Psychiatry. 10.1176/appi.ajp.2014. Retrieved from https://hdl.handle.net/10161/9020.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Jed Eugene Rose
Professor in Psychiatry and Behavioral Sciences
We are pursuing three main lines of research: 1) Brain imaging of the effects of
nicotine and cigarette smoking: We have used Positron Emission Tomography (PET) methods
to analyze regional cerebral blood flow responses to nicotine, administered either
intravenously or inhaled in cigarettes. Our aim is to identify brain substrates mediating
the addictive properties of nicotine. Preliminary results have shown alterations
in the pattern of regional cerebral blood flow, involving

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