Bupropion SR for the treatment of smokeless tobacco use

Background: No pharmacotherapies have been shown to increase long-term (>= 6 months) tobacco abstinence rates among smokeless tobacco (ST) users. Bupropion SR has demonstrated potential efficacy for ST users in pilot studies. We conducted a multicenter, randomized, double-blind, placebo-controlled, clinical trial to assess the efficacy and safety of bupropion SR for tobacco abstinence among ST users. Methods: Adult ST users were randomized to bupropion SR titrated to 150 mg twice daily (N= 113) or placebo (N= 112) for 12 weeks plus behavioral intervention. The primary endpoint was the 7-day point-prevalence tobacco abstinence rate at week 12. Secondary outcomes included prolonged and continuous tobacco abstinence rates, craving and nicotine withdrawal, and weight gain. Results: The 7-day point-prevalence tobacco abstinence rates did not differ between bupropion SR and placebo at the end treatment (53.1% versus 46.4%; odds ratio (OR) 1.3;p=0.301). The 7-day point-prevalence abstinence did not differ at weeks 24 and 52. The prolonged and continuous tobacco abstinence rates did not differ at weeks 12, 24, and 52. A time-by-treatment interaction was observed in craving over time with greater decreases in the bupropion SR group. At 12 weeks, the mean (+/- S.D.) weight change from baseline among abstinent subjects was an increase of 1.7 (+/- 2.9) kg for the bupropion SR group compared to 3.2 ( +/- 2.7) kg for placebo (p=0.005). Conclusions: Bupropion SR did not significantly increase tobacco abstinence rates among ST users, but it significantly decreased craving and weight gain over the treatment period. (c) 2007 Elsevier Ireland Ltd. All rights reserved.