Two drugs in combination might be better than one when it comes to helping hardcore smokers quit, at least in the short term, a new study suggests.
The drugs -- varenicline (sold under the brand name Chantix) and bupropion (Wellbutrin) -- taken together increase the rates of quitting over 12 weeks compared with Chantix alone, the researchers found. After a year, however, relapse rates were similar using both approaches.
"We believe this evidence strongly supports the idea that varenicline helps everybody quit," said lead researcher Dr. Jon Ebbert, a professor of medicine at the Mayo Clinic in Rochester, Minn. "But for heavier smokers and more dependent smokers, combination therapy with varenicline plus bupropion will increase quit rates more than varenicline alone."
"This is how we are going to treat patients," he said.
Combination therapy works better than a single medication because the two drugs act in different ways, Ebbert said.
"With any addiction there are multiple parts of the brain involved," he said. "These drugs have different effects on the brain. Perhaps one of the keys to treatment of any addiction may be to target different parts of the brain to increase success."
The study, published in the Jan. 8 issue of the Journal of the American Medical Association, found that although many quitters relapsed, a significant number who had combination therapy didn't take up the habit again.
"You're looking at a 30 percent quit rate [with combination therapy] versus a 24 percent quit rate [with one drug]," Ebbert said.
It's not surprising that many people eventually reached for cigarettes again, he said.
"Relapse is part of the addiction process," Ebbert said. "The important part of long-term treatment of these patients is to re-engage them in the quitting process and use different types of medication in combination with each other to increase quit rates."
Dr. Len Horovitz, a pulmonary specialist at Lenox Hill Hospital in New York City, said breaking an entrenched smoking habit likely will take more than drug therapy.
"Behavioral therapies clearly need to be considered," Horovitz said.
Ebbert agreed, and said counseling to help patients overcome some behavioral aspects of tobacco addiction was offered to all of the study participants.
Dr. Sidney Braman, a senior faculty member in pulmonary, critical care and sleep medicine at Mount Sinai Hospital in New York City, said most smokers who eventually quit have tried an average of six times to break the habit.
"Most trials of smoking cessation have shown that the long-term success rate is a tough nut to crack," he said.
Braman said he anticipates that significant advances in understanding -- and therefore treating -- addiction will be made in the near future.
Until then, Braman said, "You have to try again and again and again."
For the study, 315 smokers were randomly selected to take Chantix and Wellbutrin or Chantix and a placebo for 12 weeks.
Ebbert's team found that 53 percent of those taking both drugs had quit smoking after 12 weeks, compared with about 43 percent of those taking Chantix alone.
After about six months, 37 percent of people in the two-drug group remained smoke-free, compared with 28 percent of those who took Chantix alone.
After a year, however, the difference narrowed, with about 31 percent in the combination group and about 25 percent of those taking Chantix alone still not smoking, the researchers found.
More patients using the combination treatment reported anxiety and depression than those taking only Chantix. "Those are important symptoms to monitor, but we don't feel it's more than would occur with normal treatment," Ebbert said.
Smoking accounts for 62 percent of deaths among women smokers and 60 percent of deaths among men who smoke, the researchers said.
