Benefits of varenicline vs. bupropion for smoking cessation: a Bayesian analysis of the interaction of reward sensitivity and treatment. Psychopharmacology (Berl) 2017 Jun;234(11):1769-1779
Date
03/10/2017Pubmed ID
28275830Pubmed Central ID
PMC5901731DOI
10.1007/s00213-017-4580-2Scopus ID
2-s2.0-85014667873 (requires institutional sign-in at Scopus site) 16 CitationsAbstract
RATIONALE: We have shown that differences in the level of neural activation to stimuli associated with smoking vs. natural rewards, a biomarker related to reward sensitivity, predict treatment outcome.
OBJECTIVES: This paper examined whether this biomarker moderates the impact of bupropion or varenicline on smoking cessation.
METHODS: Prior to treatment randomization, smokers (N = 180) in a placebo-controlled trial using bupropion and varenicline completed event-related potential recording (late positive potential, LPP) while viewing pleasant (P), cigarette (C)-related, and other pictures. We used Bayesian models to estimate the probability of interaction between treatment and the LPP for both efficacy and comparative effectiveness analyses.
RESULTS: Efficacy analysis showed that smokers with more neural activation to pleasant vs. cigarette-related stimuli (P > C) had a 98-99% chance of achieving greater abstinence than placebo (OR >1.00), using either medication from the end of treatment (EOT, primary outcome) through the 3-month follow-up. Relative to placebo, smokers with higher activation to cigarette-related vs. pleasant stimuli (C > P) had a 99% chance of increased benefit from varenicline at both time points (OR >1), but only 67 and 43% with bupropion at the EOT and 3-month follow-up, respectively. Comparative effectiveness analysis found that smokers with the C > P activation pattern had a 95-98% chance of benefit from varenicline vs. bupropion, while P > C smokers had a 50-58% chance of similar improvement with varenicline at the EOT and 3 months.
CONCLUSIONS: Varenicline appears to be the treatment of choice for smokers with the C > P pattern of neural activation, while for those showing P > C, varenicline and bupropion have similar efficacy.
Author List
Cinciripini PM, Green CE, Robinson JD, Karam-Hage M, Engelmann JM, Minnix JA, Wetter DW, Versace FMESH terms used to index this publication - Major topics in bold
AdultAntidepressive Agents, Second-Generation
Bayes Theorem
Bupropion
Follow-Up Studies
Humans
Middle Aged
Nicotinic Agonists
Reward
Smoking Cessation
Tobacco Smoking
Treatment Outcome
Varenicline