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November 5, 2012Nicotine & Tobacco Research

Compared with varenicline monotherapy (32.1% success), patients who used bupropion + SRI adjuvant treatment (57.7% success) had an OR of 5.05 (95% CI 1.99-12.80) for successful treatment response at 1 year.

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Why the study?

Does the addition of bupropion and/or SRIs to varenicline improve smoking cessation rates compared to varenicline monotherapy in cardiovascular patients?

Population

427 patients in a specific cardiovascular smoking cessation service

Comparison

Varenicline combined with bupropion and/or… vs Varenicline monotherapy

Design

Cohort

Follow-up

52 weeks

Authors

JIJaqueline Schölz IssaTATânia Ogawa AbeSMSimone Moura

Discussion

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Overview

May support adjunctive bupropion plus SRI in cardiovascular smokers on varenicline; leaves open confirmation in randomized trials.

Key Points

  • To evaluate the real-world effectiveness of varenicline monotherapy compared with combination regimens incorporating bupropion, serotonin reuptake inhibitors (SRIs), or both in a specialized cardiovascular smoking cessation service.
  • Conducted an outcome study involving 427 patients treated with varenicline alone or alongside adjuvant therapies and followed for 52 weeks.
  • Varenicline was prescribed for up to 12 weeks, with SRIs added for emerging mood changes and bupropion added for persistent withdrawal symptoms or failure to quit within 2 to 3 weeks.
  • The 52-week continuous abstinence rates were 32.1% for varenicline monotherapy, 50.6% for varenicline plus SRI, 55.0% for varenicline plus bupropion, and 57.7% for varenicline plus bupropion and SRI.
  • Multivariate analysis showed higher odds of 1-year cessation for adjuvant bupropion (OR 3.21, 95% CI 1.68–6.14), adjuvant SRI (OR 3.58, 95% CI 1.98–6.48), and combined bupropion plus SRI (OR 5.05, 95% CI 1.99–12.80) compared with varenicline monotherapy.

Structured PICO

Does the addition of bupropion and/or SRIs to varenicline improve smoking cessation rates compared to varenicline monotherapy in cardiovascular patients?

P
Population
427 patients in a specific cardiovascular smoking cessation service
I
Intervention
Varenicline combined with bupropion and/or serotonin reuptake inhibitors (SRIs) (varenicline taken until week 12, with bupropion/SRIs added based on symptoms or lack of abstinence)
C
Comparator
Varenicline monotherapy
O
Outcome
Continuous abstinence rate at 52 weeks

Adding bupropion and/or SRIs to varenicline in a real-world cardiovascular smoking cessation program may significantly improve 1-year continuous abstinence rates compared to varenicline alone.

Limitations

  • Observational design requiring confirmation in randomized controlled trials
  • Treatment by indication (adjuvant therapies were prescribed based on mood changes or failure to achieve early abstinence)

Cite This Study

Issa et al. (2012) studied this question.

synapsesocial.com/papers/6a6fafa18031ec7bb1dbe354https://doi.org/10.1093/ntr/nts230
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Efficacy of combined varenicline and nicotine replacement therapy compared with varenicline or nicotine replacement therapy alone for smoking cessation: A systematic review and meta‐analysis2025
  2. 2Efficacy of combined varenicline and nicotine replacement therapy compared with varenicline or nicotine replacement therapy alone for smoking cessation: A systematic review and meta‐analysis2025 · 9 citations
  3. 3Addition of Bupropion or Varenicline to Nicotine Replacement Therapy After Acute Coronary Syndrome: A Propensity-Matched Real-World Analysis2026
  4. 4Effects of Combined Varenicline With Nicotine Patch and of Extended Treatment Duration on Smoking Cessation2021 · 60 citations
  5. 5Efficacy of bupropion and varenicline genetic markers in choosing pharmacological treatment for smoking cessation, and implications for combining drugs: A randomized controlled trial (GENTSMOKING)2024 · 1 citations