According to a recent meta-analysis published in the journal Comprehensive Psychiatry, a combination therapy for smoking cessation with varenicline and bupropion could substantially improve outcomes.
Researchers conducted a meta-analysis of four randomised controlled trials (RCTs; n=1230) identified through a literature search on the PubMed, EMBASE, Cochrane Library and Web of Science databases.
The varenicline plus bupropion combination significantly improved the abstinence rate at the end of treatment (relative risk [RR], 1.153; 95% CI, 1.019-1.305; P=.024) compared with varenicline monotherapy. The benefit persisted at six months of follow-up (RR, 1.231; 95% CI, 1.017-1.490; P=.033) but not at 12 months (RR, 1.130; 95% CI, 0.894-1.428; P=.305). The benefit was pronounced in highly dependent smokers (RR, 1.631; 95% CI, 1.290-2.061; P<.001) and heavy smokers (RR, 1.515; 95% CI, 1.226-1.873; P<.001). The combination therapy was associated with higher rates of anxiety and insomnia symptoms compared with varenicline monotherapy.
The authors concluded: "Compared with varenicline monotherapy, combination therapy of varenicline and bupropion can significantly improve the abstinence rate at the end of treatment and 6 months follow-up, mainly in highly dependent smokers and heavy smokers." They call for additional RCTs with long-term follow-up to strengthen the findings.
