Drug best agent for quitting smoking, study says
By Neil Rosenberg
of the Journal Sentinel staff
novembre 26, 2004
An anti-smoking pill -- marketed originally as an anti-depressant -- has been shown to
be the best single agent ever in getting people to quit cigarettes, helping about a third
of those who take it quit for at least a year, according to research released Wednesday.
The study, headed by researchers at the University of Wisconsin-Madison, found that
Zyban was nearly twice as effective as nicotine patches, producing a 30.3% quit rate
compared with 16.4% for nicotine patches and 15.6% for a placebo.
The quit rate rose to 35.5% a year out for those who had used both Zyban and nicotine
patches, according to the report in the New England Journal of Medicine.
The study was reputed to be the first to test Zyban head to head with other smoking
cessation products and to examine its safety when used with nicotine replacement therapy.
Another unexpected benefit: those using the drugs experienced less weight gain -- a
common problem among those who try to quit smoking -- than those using a placebo. The
weight gain was about the same for Zyban and nicotine patch users but least of all for
those who used both patches and the drug.
"This is great news for smokers who are motivated to quit," said Michael
Fiore, director of the Center for Tobacco Research and Intervention at UW that
participated in the study. "It is a medicine, clearly shown in this study, to be the
most effective medicine for smokers who intend to quit."
But he added a cautionary note, "This is not a magic bullet. Quitting smoking is
still tough work."
The drug, known generically as bupropion, works by acting directly on the areas of the
brain where nicotine cravings occur when someone is hooked on cigarettes. It blunts those
cravings and physical withdrawal symptoms, such as irritability and shortened attention
span, said Douglas Jorenby, assistant professor of medicine at UW and principal
investigator of the study.
"These findings indicate that bupropion should be viewed as first-line therapy for
smoking cessation," Jorenby said.
"I have found it to be just short of miraculous," said Milwaukee pulmonary
specialist Steve Brown, who has been prescribing the drug for his smoking patients since
December 1997. "They see a pack of cigarettes sitting in front of them, and they have
no urge whatsoever."
Brown emphasized, however, that it should be used as part of a three-pronged smoking
cessation program that also includes stress reduction techniques and behavioral
modification training.
The study was financed by Glaxo Wellcome, a major pharmaceutical firm that makes and
markets Zyban. Both Jorenby and Fiore have organized medical education presentations
sponsored by Glaxo, and Fiore is a consultant to the company as well. But Jorenby said
there were no strings attached to the study and that the firm had no right to review the
study results or to decide when or where they could be published.
The New England Journal of Medicine is one of the most prestigious medical journals in
the world and is a "peer review" publication. That means articles must pass
muster by a group of independent experts who carefully examine study methods and whether
results claimed are warranted.
The drug is not for everybody, and in some people it could be dangerous. It is not for
anyone who has had a seizure or seizure disorder because it increases the risk of seizure.
Chronic alcohol abusers cannot take it because of the increased seizure risk. Those on
certain types of anti-depressants cannot take it, nor can those with eating disorders.
It also has side effects bothersome enough that 12% in the Zyban group stopped taking
it. Principal side effects include dry mouth and insomnia.
Bupropion was originally developed and approved as an anti-depressant and is sold for
that purpose under the name of Wellbutrin. In May 1997, it was approved by the Food and
Drug Administration for use as a smoking cessation aid. Since then more than 4 million
prescriptions have been written for the anti-smoking drug, according to Glaxo Wellcome.
The drug is typically given for a few days to about a week before a cold-turkey quit
date in order to allow drug blood levels to rise sufficiently. It is then given twice a
day for about several months. In the study, it was given for a total of nine weeks. But
the quit rates were measured at 12 months after a person initially quit.
The drug costs about $90 for a month's supply, roughly comparable to nicotine patches,
which cost anywhere from $60 to $100 for a month's supply. However, many major managed
care programs do not reimburse for Zyban.
Brown said he gives it for two to six months, cautioning that it should not be given
indefinitely. "This is not like methadone," he said. "It is not intended to
be given for a lifetime."
For Michael Sardina, of Milwaukee, a longtime smoker of two to three packs a day, the
results were stunningly quick. Sardina, 48, who had smoked since he was a teenager, had
attempted to quit many times before.
After a heart attack last year, he tried Zyban. On the 10th day after starting the
drug, he lit his last cigarette.
Once on the drug, Sardina said, smoking lost its zip.
"It was like sucking on a cigarette after it's lit and had been doused with
water," he said of a cigarette's lack of appeal once on the drug. "You got no
satisfaction." His last cigarette was nine months ago.
Both Jorenby and Fiore said they were surprised that the drug was so much better than
the nicotine patch and that the two together did not dramatically improve the quit rate.
Both Jorenby and Brown suggested that the quit rates would be even higher if the drug
had been used with nicotine gum or inhalers, which can be used at any time a craving
strikes. Patches, on the other hand, deliver a daylong steady stream of nicotine that does
not mimic the nicotine surges felt by a cigarette smoker.
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