Benefits of varenicline vs. bupropion for smoking cessation: a Bayesian analysis of the interaction of reward sensitivity and treatment

Abstract

Rationale We have shown that differences in the level of neural activation to stimuli associated with smoking vs. natural rewards, a biomarker related to reward sensitivity, predict treatment outcome. Objectives This paper examined whether this biomarker moderates the impact of bupropion or varenicline on smoking cessation. Methods Prior to treatment randomization, smokers (N = 180) in a placebo-controlled trial using bupropion and varenicline completed event-related potential recording (late positive potential, LPP) while viewing pleasant (P), cigarette (C)-related, and other pictures. We used Bayesian models to estimate the probability of interaction between treatment and the LPP for both efficacy and comparative effectiveness analyses. Results Efficacy analysis showed that smokers with more neural activation to pleasant vs. cigarette-related stimuli (P > C) had a 98–99% chance of achieving greater abstinence than placebo (OR >1.00), using either medication from the end of treatment (EOT, primary outcome) through the 3-month follow-up. Relative to placebo, smokers with higher activation to cigarette-related vs. pleasant stimuli (C > P) had a 99% chance of increased benefit from varenicline at both time points (OR >1), but only 67 and 43% with bupropion at the EOT and 3-month follow-up, respectively. Comparative effectiveness analysis found that smokers with the C > P activation pattern had a 95–98% chance of benefit from varenicline vs. bupropion, while P > C smokers had a 50–58% chance of similar improvement with varenicline at the EOT and 3 months. Conclusions Varenicline appears to be the treatment of choice for smokers with the C > P pattern of neural activation, while for those showing P > C, varenicline and bupropion have similar efficacy.

The reality of “food porn”: Larger brain responses to food‐related cues than to erotic images predict cue‐induced eating

“…One is that it can be used to classify individuals only after the complete sample has been collected. This feature limits the possibility to use it in clinical settings, where individuals should be classified on a subject‐by‐subject basis to effectively use the classification outcomes to tailor treatments (Cinciripini et al, ). To overcome this limitation, we are currently testing the extent to which discriminant functions (Duarte Silva & Stam, ) can be used to classify individuals on a subject‐by‐subject basis to then tailor treatments to the specific characteristics of the patient (Versace, Claiborne, et al, ).…”

Discovery and development of varenicline for smoking cessation

“…However, three weeks of varenicline treatment attenuated ventral striatal and OFC activation by smoking cues and reduced subjective craving 74 . An event related potential study found that smokers with greater activation to cigarette-related cues over other pleasant stimuli had a 95–98% greater chance of benefit for varenicline over bupropion, and were more likely to remain abstinent at three-month follow-up 75 . Moreover, at six-month follow-up all smokers maintained abstinence on varenicline significantly more than on placebo, an effect driven largely by increased activation to cigarette cues 75 .…”

“…An event related potential study found that smokers with greater activation to cigarette-related cues over other pleasant stimuli had a 95–98% greater chance of benefit for varenicline over bupropion, and were more likely to remain abstinent at three-month follow-up 75 . Moreover, at six-month follow-up all smokers maintained abstinence on varenicline significantly more than on placebo, an effect driven largely by increased activation to cigarette cues 75 . Together, these findings suggest that attenuation of the salience attributed to smoking and cigarette-related cues may critically underlie varenicline’s efficacy as a smoking cessation aid.…”

Event-Related Potentials as Biomarkers of Behavior Change Mechanisms in Substance Use Disorder Treatment

“…Several studies have also suggested that error-related brain activity (i.e., ERN) may serve as a useful biomarker for SUD relapse (29, 117). Smoking cessation studies involving pharmacological treatment and counseling have demonstrated attentional bias as indexed by late positive potential (LPP) amplitude suggesting that salience of non-drug reward is related to ability to abstain (118, 119). Similarly, in individuals with cocaine use disorder, increases in LPP amplitude in response to pleasant stimuli (compared to drug-related stimuli) were related to decreased drug craving six months post-treatment (63).…”

“…Key processes in MI/MET include fostering motivation to change, identifying values-incongruent actions, and increasing the pursuit of alternative, non-drug goal-directed behavior. The late positive potential (LPP) is thought to reflect motivated attention (131) and has been examined across different SUDs (63, 118, 119, 132, 133) to evaluate motivation toward drug cues. The response-locked error-related negativity (ERN) is a neurophysiological measure of an endogenous performance monitoring system that promotes cognitive control and post-error compensatory behavioral adjustments (134, 135).…”