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Bupropion for hospital-based smoking cessation

Institution: University of California, San Francisco
Investigator(s): Joel Simon, M.D., M.P.H.
Award Cycle: 2003 (Cycle 12) Grant #: 12RT-0148 Award: $478,065
Subject Area: Tobacco-Use Prevention and Cessation
Award Type: Research Project Awards

Initial Award Abstract
Introduction: Smoking remains the single largest cause of premature loss of life in the US and accounts for more than 440,000 deaths annually. If the Healthy People 2010 goals are to be met, i.e., a smoking prevalence rate of 12% of US adults, new smoking cessation approaches will be needed. Millions of adult smokers are hospitalized yearly, providing a window of opportunity for smoking cessation interventions. The Agency for Health Care Policy and Research guidelines recommend all hospitalized smokers be offered smoking cessation treatment during hospital admissions. To date, however, relatively few controlled clinical trials have examined whether hospital-based smoking cessation interventions are effective.

Topic Addressed: There are no published clinical trials that have examined the efficacy of bupropion fro smoking cessation when begun during hospitalization. With the exception of one on-going NIH-funded clinical trial among patients with acute coronary syndromes, there are no other studies focusing in the potential effectiveness of bupropion in the hospital setting.

Progress Toward Specific Aims: After hiring and training study personnel and addressing all the administrative and logistical requirements for conducting a clinical trial, we began recruitment in late 2003 - early 2004. Because of a secular trend of decreased hospital admission rates and a decreased prevalence of smoking among northern California veterans, we have experienced delays in enrollment. To date, we have recruited 7 participants. To address the hurdles encountered with recruiting participants we have broadened the entry criteria (e.g., no longer excluding patients with stable treated depression or chronic pain patients on stable doses of narcotic analgesics) and importantly, we have increased reimbursement from $40 to $200. The increased reimbursement has increase interest in the study.

Future Directions: Because initial recruitment has been slow, we have had decreased study-related expenses regarding the purchase of study medication. Additionally, we have achieved economies in salary support for personnel during the first year of the study and hope to apply these savings toward an additional 6 to 12 months of recruiting. We have also discussed out study with Dr. Nancy Rigotti who has agreed in principle to pool the data collected from this study with her recently completed NIH-funded study of bupropion for smokers hospitalized with myocardial infarction. Combining the data from the 2 studies should permit a better assessment of the efficacy of bupropion begun in the hospital setting.

Impact: Nicotine replacement therapy (NRT) is discouraged after many surgical procedures because of its potentially deleterious effects on wound healing. Hence, alternative pharmacologic approaches to aid hospitalized smokers who want to quit and who cannot use NRT are needed.