Nicotine patch efficacy unaffected by bupropion.
There is a paucity of controlled studies assessing strategies for adolescent smoking cessation. Nonetheless, teenage smoking remains an "alarming public health problem," according to the study's authors (J. Consult. Clin. Psychol. 2004;72:729-35). Self-reported daily smoking is 7% among 8th graders, 14% among 10th graders, and 21% among 12th graders, according to the 2000 Monitoring the Future survey.
Joel D. Killen, Ph.D., professor of medicine at Stanford (Calif.) University, and his colleagues assessed 211 high school smokers. Most were male (145 participants); the age range was 15-18 years. Following parental consent, participants were randomized to a nicotine patch plus placebo or nicotine patch plus 150 mg bupropion SR daily.
Researchers prescribed nicotine patches for 8 weeks and bupropion for 9 weeks, and they conducted weekly group skills training for all participants.
The training emphasized self-regulatory skills and action plans for self-identified, high-risk situations. The groups did not differ in time to relapse. Therefore, results did not support their hypothesis that combination therapy would improve adherence to smoking abstinence at 10 weeks and 26 weeks. The finding is inconsistent with the one published trial that found the same combination effective in adults (N. Engl. J. Med. 1999;340:685-91).
The investigators proposed that inadequate dosing and/or poor compliance may have contributed to bupropion's lack of efficacy.
Because pediatric patients were not included in preclinical safety and efficacy studies, the researchers chose a dose of 150 mg/day. The recommended dosage for adults is 300 mg/day. Although 80% of teenagers in the study attended at least eight treatment sessions, only 29% reported they used all their nicotine patches for at least 5 treatment weeks.
A positive outcome was that a large majority of adolescents in both treatment groups reduced their smoking to a few cigarettes per day.
Although smoking was self-reported, it was verified with expired air carbon monoxide levels taken throughout the study.
"Treatments of the kind examined in this report, augmented by extended maintenance therapies, may yield a more durable treatment response," the authors concluded.
BY DAMIAN MCNAMARA