Rose Jed E, Behm Frédérique M
From the Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, N.C.
Am J Psychiatry. 2014 Nov 1;171(11):1199-205. doi: 10.1176/appi.ajp.2014.13050595.
The authors assessed the efficacy and safety of combination treatment with varenicline and sustained-release bupropion for smokers who, based on an assessment of initial smoking reduction prior to the quit date, were deemed unlikely to achieve abstinence using nicotine patch treatment.
In a randomized, double-blind, parallel-group adaptive treatment trial, the authors identified 222 cigarette smokers who failed to show a reduction of more than 50% in smoking after 1 week of nicotine patch treatment. Smokers were randomly assigned to receive 12 weeks of varenicline plus bupropion or varenicline plus placebo. The primary outcome measure was continuous smoking abstinence at weeks 8-11 after the target quit date.
Both treatments were well tolerated. Participants who received the combination treatment had a significantly higher abstinence rate than those who received varenicline plus placebo (39.8% compared with 25.9%; odds ratio=1.89; 95% CI=1.07, 3.35). Combination treatment had a significantly greater effect on abstinence rate in male smokers (odds ratio=4.26; 95% CI=1.73, 10.49) than in female smokers (odds ratio=0.94; 95% CI=0.43, 2.05). It also had a significantly greater effect in highly nicotine-dependent smokers (odds ratio=3.51, 95% CI=1.64, 7.51) than in smokers with lower levels of dependence (odds ratio=0.71, 95% CI=0.28, 1.80).
Among smokers who did not show a sufficient initial response to prequit nicotine patch treatment, combination treatment with varenicline and bupropion proved more efficacious than varenicline alone for male smokers and for smokers with a high degree of nicotine dependence.
作者评估了伐尼克兰与缓释安非他酮联合治疗对吸烟者的疗效和安全性，这些吸烟者基于戒烟日期前初始吸烟量减少情况的评估，被认为使用尼古丁贴片治疗不太可能实现戒烟。
在一项随机、双盲、平行组适应性治疗试验中，作者确定了222名吸烟者，他们在接受1周尼古丁贴片治疗后吸烟量未减少超过50%。吸烟者被随机分配接受12周的伐尼克兰加安非他酮或伐尼克兰加安慰剂治疗。主要结局指标是目标戒烟日期后第8至11周的持续戒烟情况。
两种治疗耐受性均良好。接受联合治疗的参与者戒烟率显著高于接受伐尼克兰加安慰剂的参与者（39.8% 对比25.9%；优势比 = 1.89；95%置信区间 = 1.07, 3.35）。联合治疗对男性吸烟者戒烟率的影响（优势比 = 4.26；95%置信区间 = 1.73, 10.49）显著大于女性吸烟者（优势比 = 0.94；95%置信区间 = 0.43, 2.05）。它对尼古丁高度依赖的吸烟者（优势比 = 3.51, 95%置信区间 = 1.64, 7.51）的影响也显著大于依赖程度较低的吸烟者（优势比 = 0.71, 95%置信区间 = 0.28, 1.80）。
在对戒烟前尼古丁贴片治疗初始反应不足的吸烟者中，伐尼克兰与安非他酮联合治疗对男性吸烟者和尼古丁高度依赖的吸烟者比单独使用伐尼克兰更有效。
