Abstract 13605: The Efficacy and Safety of Bupropion Started In-Hospital for Smoking Cessation in Patients with Cardiovascular Disease: A Systematic Review and Meta-Analysis
Background: Hospitalization for cardiovascular disease (CVD) provides a unique opportunity for administration of smoking cessation therapies. Randomized controlled trials investigating the efficacy of bupropion have yielded inconclusive results. A meta-analysis of randomized controlled trials (RCTs) was performed to determine the efficacy and safety of bupropion started in-hospital for smoking cessation in patients with CVD.
Methods: We systematically searched the medical literature, from inception to May 2011, to identify RCTs of bupropion therapy started in-hospital for smoking cessation in CVD patients. RCTs that reported smoking abstinence at 6 or 12 months were included in our analysis. Smoking abstinence was defined using the most conservative outcome reported in identified RCTs.
Results: Three RCTs involving 773 patients met our inclusion criteria. Studies ranged in size from 149 to 392 patients, with 381 receiving bupropion and 392 receiving placebo treatment. The length of treatment varied from 8 to 12 weeks in the included studies. All studies reported a 12 month follow-up. Participants were predominantly male (80%) and the mean age ranged from 52 to 57. The majority of patients were hospitalized with acute coronary syndrome (86%). At 12 months, bupropion therapy was not associated with a significant increase in continuous abstinence rates over placebo (OR 1.24 [95% CI 0.89, 1.74]). A similar trend was observed for 12-month point prevalence abstinence (OR 1.25 [95% CI 0.89, 1.77]). A qualitative comparison, suggested similar rates of adverse events in both groups.
Conclusions: Bupropion therapy started in-hospital did not appear to increase 12-month abstinence rates over placebo in CVD patients, although an effect cannot be excluded due to wide confidence intervals. Our study highlights the need for larger RCTs to determine the long-term efficacy and safety of bupropion in CVD patients.
- © 2011 by American Heart Association, Inc.