The efficacy of the combination of sertraline with buspirone for smoking cessation

Abstract

In a double-blind placebo-controlled trial, we evaluated the efficacy of the combination of sertraline and buspirone plus cognitive-behavioral treatment to promote tobacco abstinence in individuals referred to a chemical dependency clinic. Ninety eight individuals 18-65 years of age were randomized to placebo or sertraline 25 mg/day for 2 days, followed by 50 mg from day 3 to 90, and buspirone 5 mg three times a day for 7 days, and 10 mg from day 8 to 90. The rate of continuous abstinence at the 26th week of follow-up, informed by the patient, was 43.5% in the active treatment group and 17.3% in the control group (p = 0.01). The odds ratio for continuous abstinence for the intervention group was 4.74 (95% CI 1.50-14.55) (adjusted for smoker households and number of cognitive sessions). Nicotine withdrawal symptoms were common in both groups (98.7% vs. 95.5% p = 0.37). The combination of sertraline and buspirone with cognitive-behavioral therapy was more effective than placebo and cognitive-behavioral therapy to promote smoking cessation.

Combinaisons des traitements pharmacologiques au cours du sevrage tabagique. Revue systématique

“…-Dans l'ECR de Carrao et al [26], les fumeurs, indemnes de comorbidités psychiatriques, étaient randomisés en deux groupes. Le premier groupe recevait pendant 90 jours un traitement associant un antidépresseur, la sertraline (25 mg/j de J1 à J2, puis 50 mg/j de J3 à J90) et la buspirone, un antagoniste du récepteur pré-synaptique à la sérotonine (5 mg, 3 fois / jour, de J1 à J7, puis 10 mg, 3 fois / jour, de J8 à J90).…”

“…La sertraline n'a pas d'affinité pour les récepteurs 5HT1A. Son action antidépressive parait liée à son action directe sur les neurones noradrénergiques au niveau du locus ceruleus ; de plus l'augmentation des taux extracellulaires de sérotonine est associée à la modulation du taux de libération de l'acétylcholine dans le système nerveux central attribuée à la nicotine [26,37,38].…”

Current pharmacologic treatments for smoking cessation and new agents undergoing clinical trials

“…Trials evaluating selective serotonin reuptake inhibitors, 44,54 anxiolytics, 55 monoamine oxidase inhibitors, [56][57][58][59][60] psychostimulants, 61 other nicotinic acetylcholine receptor agonists and antagonists, 62 quinine-methyl valerate-camphor-eucalyptus oil, [63][64][65] opioid antagonists, [66][67][68] selective cannabinoid type-1 receptor inverse agonists, 69,70 silver acetate, 71 supplements, 56 other tricyclic antidepressants, 56 5-hydroxytryptamine-3 antagonists, 72,73 agonists of α-type peroxisome proliferator-activated receptors, 74 N-methyl-D-aspartate receptor modulators, 75 cycloserine, 76 memantine, 77 dopamine enhancers and receptor modulators, 78 and nicotine vaccines 79,80 have failed to show clear benefits for smoking cessation. 81 Trials on new pharmacologic treatments that could aid smoking cessation New pharmacologic agents to aid smoking cessation are in the early stages of clinical trials.…”

Current and Emerging Pharmacotherapies for Cessation of Tobacco Smoking

“…A later double‐blind placebo‐controlled trial evaluated the efficacy of the combination of sertraline and buspirone plus cognitive‐behavioral treatment versus cognitive‐behavioral treatment alone to promote tobacco abstinence . Although the rate of continuous abstinence at week 26 of follow‐up was 43.5% in the active treatment group and 17.3% in the control group (p=0.01), and the OR for continuous abstinence for the active treatment group was 4.74 (95% CI 1.50–14.55), the trial did have methodological limitations including the absence of any biochemical validation of abstinence.…”