Date of Award

2014

Degree Type

Selective Evidence-Based Medicine Review

Degree Name

Master of Science in Health Sciences - Physician Assistant

Department Chair

John Cavenagh, PhD, PA-C

Abstract

OBJECTIVE: The objective of this selective EBM review is to determine whether or not antidepressants are effective for smoking cessation in African American smokers aged 18 and older.

STUDY DESIGN: Review of two randomized controlled trials published in 2002 and 2011 and one pilot randomized control trial published in 2011, all English language.

DATA SOURCES: Two randomized, double-blind, controlled trials comparing bupropion to a placebo group and one pilot randomized controlled trial comparing varenicline with adherence support for smoking cessation to the control without adherence support. All articles were found using Medline, PubMed, and OVID.

OUTCOMES MEASURED: Smoking cessation was determined on cotinine and/or carbon monoxide verified samples; reduction in cigarettes smoked per day based on patient self-report; adverse effects of treatment were obtained with use of a prompted checklist containing the 10 most common symptoms associated with quitting smoking and smoking cessation pharmacotherapy, and with the National Cancer Institute’s Common Toxicity Criteria for Adverse Events.

RESULTS: Cox and Ahluwalia demonstrated that bupropion was effective for smoking cessation over seven weeks, however results were inconclusive for long-term abstinence. Nollen reported that adherence support was ineffective at promoting smoking abstinence in African American smokers utilizing varenicline as a cessation aid.

CONCLUSIONS: The results of the randomized controlled trials reviewed demonstrate that the antidepressant drug, bupropion, given over seven weeks, was safe and effective for smoking cessation in African American light and heavy smokers. Evidence is inconclusive to support the efficacy of bupropion for long-term smoking cessation. In the pilot trial, there was no significant difference between the treatment receiving varenicline with adherence support and the control, however, there was a significant reduction in cigarettes smoked per day; these results need to be interpreted with caution due to limitations in study design being that the sample size was insufficient and a control arm receiving placebo was not included in the study. Further studies with larger sample sizes are warranted to compare the safety and efficacy of bupropion versus varenicline since limited studies exist surrounding non-nicotine replacement smoking cessation aids in African American smokers.

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