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Nicotine Patch Therapy Based on Smoking Rate Followed by Bupropion for Prevention of Relapse to Smoking

Richard D. Hurt, James E. Krook, Ivana T. Croghan, Charles L. Loprinzi, Jeff A. Sloan, Paul J. Novotny, Carl G. Kardinal, James A. Knost, Maria Tria Tirona, Ferdinand Addo, Roscoe F. Morton, John C. Michalak, Paul L. Schaefer, Patricia A. Porter, Philip J. Stella

From the Mayo Clinic and Mayo Foundation, Rochester, and Duluth Community Clinical Oncology Program (CCOP), Duluth, MN; Ochsner CCOP, New Orleans, LA; Illinois Oncology Research Association, CCOP, Peoria, IL; Saskatoon Cancer Centre, Saskatoon; Allan Blair Cancer Centre, Regina, Saskatchewan, Canada; Medcenter One Health Systems, and Mid Dakota Clinic, Bismarck, ND; Iowa Oncology Research Association CCOP, Des Moines; Siouxland Hematology-Oncology Associates, Sioux City, IA; Toledo Community Hospital Oncology Program CCOP, Toledo, OH; Geisinger Clinic and Medical Center CCOP, Danville, PA; and Ann Arbor Regional CCOP, Ann Arbor, MI.

Address reprint requests to Richard D. Hurt, MD, Mayo Clinic, 200 First St, SW, Rochester, MN 55905; email: rhurt{at}mayo.edu.

Purpose: To determine whether (1) tailored nicotine patch therapy that is based on smoking rate can be carried out in a multisite oncology investigative group practice setting, (2) long-term use of bupropion reduces the rate of relapse to smoking in smokers who stop smoking with nicotine patch therapy, and (3) bupropion can initiate smoking abstinence among smokers who have failed to stop smoking after nicotine patch therapy.

Participants and Methods: Fourteen North Central Cancer Treatment Group sites recruited generally healthy adult smokers from the general population for nicotine patch therapy and based the patch dosage on smoking rates. At completion of nicotine patch therapy, nonsmoking participants were eligible to be assigned to bupropion or placebo for 6 months (for relapse prevention). and smoking participants were eligible to be assigned to bupropion or placebo for 8 weeks of treatment.

Results: Of 578 subjects, 31% were abstinent from smoking at the end of nicotine patch therapy. Of those subjects not smoking at the end of nicotine patch therapy who entered the relapse prevention phase, 28% and 25% were not smoking at 6 months (the end of the medication phase) for bupropion and placebo, respectively (P = .73). For those still smoking at the end of nicotine patch therapy, 3.1% and 0.0% stopped smoking with bupropion or placebo, respectively (P = .12).

Conclusion: Tailored nicotine patch therapy for the general population of smokers can be provided in a multisite oncology investigative group setting. Bupropion did not reduce relapse to smoking in smokers who stopped smoking with nicotine patch therapy. Bupropion did not initiate abstinence among smokers who failed to stop smoking with nicotine patch therapy.

Supported by the National Cancer Institute through the North Central Cancer Treatment Group. Supported in part by Public Health Service grants CA-25224, CA-37404, CA-15083, CA-63826, CA-35272, CA-35113, CA-35101, CA-35103, CA-35415, CA-35448, CA-63848, CA-52352, CA-35195, and CA-35103. Medication was supplied by Glaxo Wellcome (Research Triangle Park, NC) and Elan Pharmaceutical (Athlone, Ireland).

Additional participating institutions include: CentraCare Clinic, St. Cloud, MN (Harold E. Windschitl); Cedar Rapids Oncology Project CCOP, Cedar Rapids, IA (Martin Wiesenfeld); Mayo Clinic and Mayo Foundation, Rochester, MN (Jan C. Buckner); Carle Cancer Center CCOP, Urbana, IL (Kendrith M. Rowland); and Sioux Community Cancer Consortium, Sioux Falls, SD (Loren K. Tschetter).

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