BMJ  2004;328 (21 February), doi:10.1136/bmj.328.7437.0-f

Filler

POEM^*

Bupropion and telephone support helps smokers quit

Question How beneficial is the combination of bupropion and telephone support to help smokers quit?

Synopsis We know that physician advice and bupropion can each help people quit smoking. This randomised controlled trial (non-blinded) was conducted in a primary care setting and included 1524 smokers. Both minimal and moderate intensity counselling were assessed along with two dosing regimens of sustained-release bupropion (150 or 300 mg per day). Minimal counselling using the Zyban advantage plan consisted of one 5-10 minute scripted phone call the day after the quit date and four progress questionnaires mailed thereafter. Moderate counselling was a telephone support programme based on strategies recommended by the US Preventive Services Task Force and included five scheduled phone calls with individualised content, mailed materials, and access to a toll-free quit line for one year. Thus, there were four groups: minimal counselling with bupropion 150 mg; moderate counselling with bupropion 150 mg; minimal counselling with bupropion 300 mg; and moderate counselling with bupropion 300 mg. The quit rates at 12 months were 24%, 31%, 26%, and 33% respectively. The majority of participants reported some adverse effect, a larger proportion of those were receiving 300 mg than taking 150 mg (76 v 68%; P = 0.002). There was a trend for patients taking the 300 mg dose to be more likely to discontinue medication because of adverse affects (31% v 26%; P = 0.07).

Bottom line Patients wishing to quit smoking will have a good chance of doing so (1 in 3-4) if they receive bupropion (Zyban) with a programme of minimal to moderate telephone counselling. Bupropion plus counselling leads to clinically important 12 month quit rates in all groups. Higher doses of bupropion (300 mg daily) produce only slightly better quit rates while increasing adverse effects and costs. More counselling results in somewhat higher quit rates, an extra 7% absolute difference, compared with minimal counselling.

Level of evidence 1b (see www.infopoems.com/levels.html). Individual randomised controlled trials (with narrow confidence interval)

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Swan GE, McAfee T, Curry SJ, et al. Effectiveness of bupropion sustained release for smoking cessation in a health care setting: a randomized trial. Arch Intern Med 2003;163: 2337-44[Abstract/Free Full Text].

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^* Patient-Oriented Evidence that Matters. See editorial ( BMJ 2002;325: 983[Free Full Text])

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