Smoking: c

Clinical bottom line (level 1a)

  1. Smokers who take bupropion compared with placebo are more likely to stop smoking (NNT = 9 at 12 months) .
  2. Smokers who take bupropion compared with nicotine patches are more likely to stop smoking (NNT = 12 at 12 months) .
  3. Adding nicotine patches to bupropion is not clearly more effective than bupropion alone.
  4. Smokers who take nortryptiline compared with placebo are more likely to stop smoking (NNT = 6 at 6 months) .
Hughes et al: Cochrane Library 2000; 2 : -
Expires June 2003

The study

Systematic review of all randomised controlled trials of
  • Patients: smokers
  • Intervention: antidepressant drugs compared with placebo or alternative therapeutic control
  • Outcome: abstinence from smoking at least 6 months from start of treatment

Articles found in all languages using Cochrane Tobacco Addiction Group trials register (indexed from Medline, Embase, SciSearch and PsycLit, and meeting abstracts), 1966 to 1999 (search terms: drug name and 'smoking' as free text terms ) and contacting investigators in the area.

Selection criteria: see above
Appraisal criteria: by 2 independent reviewers: using method of randomisation and completeness of follow-up
Articles excluded if:
  • trials lasted less than 6 months
  • nicotine, clonidine or lobeline used for smoking cessation
10 studies found: 5 on bupropion, 1 on moclobemide, sertraline and venlafaxine, 2 on nortryptiline and fluoxetine

The evidence

Outcome Time to outcome CER OR
(95% CI)		 NNT
(95% CI)
smoking abstinence: bupropion v. placebo 12 months 34/430
(7.9%)		 2.73
(1.90 to 3.94) 		9
(6 to 16)
smoking abstinence: buproprion v. nicotine patch 12 months 24/244
(9.8%)		 2.03
(1.22 to 3.37) 		12
(6 to 52)
smoking cessation: bupropion + patch v. nicotine patch alone 12 months 24/244
(9.8%)		 2.53
(1.57 to 4.10) 		8
(5 to 21)
smoking cessation: bupropion + nicotine patch v. bupropion 12 months 45/244
(18.4%)		 1.28
(0.82 to 1.98) 		25
(NNT = 8 to infinity;
NNH = 36 to infinity)
long-term smoking cessation: nortryptiline v. placebo 6 months 15/106
(14.2%)		 2.83
(1.59 to 5.03) 		6
(3 to 15)

  • A small benefit was found using fluoxetine.
  • No clear effect on smoking cessation was found for sertraline, venlafaxine or moclobemide.

Comments

  1. Studies were generally small, and other smoking systematic reviews have demonstrated evidence of publication bias.

Citation

  1. Hughes LF, Stead LF, Lanacaster T, et al: anxiolytics and antidepressants for smoking cessation. Cochrane Library 2000; 2 : -
Search Terms: bupropion in Cochrane Library
Contributor: Chris Ball, June 2000
Reviewer:

Clinical Question.
Patient smokers
Intervention or Exposure antidepressants: bupropion, nortryptiline
Outcome long-term smoking cessation