A Cochrane review «Nicotine replacement therapy versus control for smoking cessation»1 «Stead LF, Perera R, Bullen C et al. Nicotine replacement therapy for smoking cessation. Cochrane Database Syst Rev 2012;(11):CD000146. »1 included 6 studies with a total of 2695 subjects. Combining nicotine replacement therapy (NRT) (patch/gum/lozenge) with bupropion was more effective than bupropion alone (RR 1.24, 95% CI 1.06 to 1.45; 4 trials, n=1991). Combining nicotine patch with bupropion was more effective than placebo (RR 3.99, 95% CI 2.03 to 7.85; 1 trial, n=405). However combining nicotine lozenge with bupropion showed no significant effect (RR 1.54, 95% CI 0.81 to 2.90; 1 trial, n=405).
Another Cochrane review «Pharmacological interventions for smoking cessation: an overview and network meta‐analysis»2 «Cahill K, Stevens S, Perera R et al. Pharmacological interventions for smoking cessation: an overview and network meta-analysis. Cochrane Database Syst Rev 2013;(5):CD009329. »2 included a network meta-analysis of 12 treatment-specific reviews (267 studies) involving 101804 participants. Bupropion was less effective than combination NRT (OR 0.68, CredI 0.5 to 0.91; indirect comparison). Bupropion was not shown to enhance the effect of NRT compared with NRT alone in 6 trials.
In an open-label RCT «Stapleton J, West R, Hajek P et al. Randomized trial of nicotine replacement therapy (NRT), bupropion and NRT plus bupropion for smoking cessation: effectiveness in clinical practice. Addiction 2013;1»3 1071 smokers received 7 weekly behavioural support sessions and were randomized to an NRT product of their choice (n = 418), bupropion (n = 409) or NRT plus bupropion (n = 244). The primary outcome was self-reported cessation over 6 months, with biochemical verification at 1 and 6 months. Abstinence rates for bupropion (27.9%) and NRT (24.2%) were not significantly different (odds ratio 1.21, 95% CI 0.883 to 1.67), and the combination rate (24.2%) was similar to that for either treatment alone. There was some evidence that the relative effectiveness of bupropion and NRT differed according to depression (χ(2) = 2.86, P = 0.091), with bupropion appearing more beneficial than NRT in those with a history of depression (29.8 versus 18.5%). Several unwanted symptoms were more common with bupropion.