OB/GYN News - Bupropion effect much better in controlled trials
NEW ORLEANS — Low-income smokers prescribed bupropion in primary care settings are less successful with smoking cessation than participants in controlled trials, according to a study presented at the annual conference of the Society of Teachers of Family Medicine.
Multicenter trials indicate that sustained-release bupropion helps 44% quit at 7 weeks, compared with 19% taking a placebo (N. Engl. J. Med. 1997;337:1195-202) and 58% of cigarette smokers quit at 9 weeks, compared with 16% taking a placebo (N. Engl. J. Med. 1999;340:685-91).
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But participants in those bupropion trials did not reflect the patient population in Fresno County, according to Evelyn Fang, M.D. The county has a 23% poverty rate (vs. 14% for California), a high rate of stroke and heart disease, and an increasing rate of lung cancer deaths.
Physicians at one family medicine clinic and two internal medicine clinics associated with the University of California, San Francisco, Fresno campus, screened and referred patients to Dr. Fang and her associates. The researchers enrolled 72 participants over 3 months from the University of California, San Francisco, Fresno residency-affiliated training sites.
Dr. Fang, who is no longer with the university, was a clinical instructor in medicine during the study. John Zweifler, M.D., also of the University of California, San Francisco, Fresno, presented the findings.
Participants got a free 30-day supply of bupropion with one refill. They took one pill daily for 3 days, then 2 daily, and were advised to stop smoking after 7 days. They were surveyed at 30 days and 60 days, with 57 having completed the follow-up.
The mean age was 47 years and 65% were female. The group was 61% Caucasian, 19% Hispanic, 18% African American, and 2% Asian. The group reported a median of two prior attempts to quit smoking, 30 years of smoking, and 17% quit at 3 months, as did 18% at 6 months.
Sustained-release bupropion may help low-income smokers in clinical settings, but the effect was much less than what has been reported in controlled trials of more motivated patients, the researchers said.
Limitations include sample size and lack of a control group.
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