Does extended pre-quit bupropion aid in extinguishing smoking behavior?
Mené auprès de 95 fumeurs adultes, cet essai évalue, du point de vue du taux d'abstinence tabagique continue à 1 mois, l'intérêt de commencer un traitement par bupropion quatre semaines avant la tentative d'arrêt du tabagisme
Introduction. Understanding the mechanisms by which bupropion promotes smoking cessation may lead to more effective treatment. To the extent that reduced smoking reinforcement is one such mechanism, a longer duration of pre-quit bupropion treatment should promote extinction of smoking behavior. We evaluated whether four weeks of pre-quit bupropion (extended run-in) results in greater pre-quit reductions in smoking rate and cotinine and, secondarily, greater short-term abstinence, than standard one week of pre-quit bupropion (standard run-in).
Methods. Adult smokers (n=95; 48 females) were randomized to a standard run-in group (n=48; 3 weeks placebo, then 1 week bupropion pre-quit) or an extended run-in group (4 weeks pre-quit bupropion; n=47). Both groups received group behavioral counseling and 7 weeks of post-quit bupropion. Smoking rate (and craving, withdrawal, and subjective effects) were collected daily during the pre-quit period; biochemical data (cotinine and CO) were collected at study visits.
Results. During the pre-quit period, the extended run-in group exhibited a greater decrease in smoking rate, compared to the standard run-in group, interaction p=0.03. Cigarette craving and salivary cotinine followed a similar pattern, though the latter was evident only among women. Biochemically verified 4-week continuous abstinence rates were higher in the extended run-in group (53%) than the standard run-in group (31%), p=0.033.
Conclusions. The extended use of bupropion prior to a quit attempt reduces smoking behavior during the pre-quit period and improved short-term abstinence rates. The data are consistent with an extinction-of-reinforcement model and support further investigation of extended run-in bupropion therapy for smoking cessation.
Nicotine & Tobacco Research , résumé, 2015