Bupropion for smoking cessation in patients hospitalized with cardiovascular disease: A systematic review and meta-analysis of randomized controlled trials

Background: Smoking remains the most important modifiable risk factor for secondary prevention of cardiovascular events. We therefore performed a meta-analysis to determine the efficacy and safety of bupropion therapy started in-hospital for smoking cessation in patients with cardiovascular disease (CVD). Methods: We systematically searched the medical literature to identify randomized controlled trials (RCTs) of in-hospital initiation of bupropion therapy for smoking cessation in patients with CVD. RCTs reporting smoking abstinence at 6 or 12 months were included. Results: Three RCTs, including 773 patients, were included in our analyses. Participants were predominantly men (range of means, 69.0%-83.8%), and the majority were hospitalized with acute coronary syndrome (ACS) (range of means, 66%-100%). Treatment duration ranged from 8-12 weeks. At the end of treatment, bupropion was associated with a significant increase in point prevalence abstinence (relative risk [RR], 1.21; 95% confidence interval [CI], 1.02-1.45) but not continuous abstinence (RR, 1.19; 95% CI, 0.97-1.45). However, bupropion was not associated with a significant increase in point prevalence abstinence (RR, 1.17; 95% CI, 0.92-1.48) or continuous abstinence (RR, 1.16; 95% CI, 0.90-1.50) at 12 months. The results of the pooled analysis for major adverse cardiac and cerebrovascular events were inconclusive (RR, 1.28; 95% CI, 0.93-1.78). Conclusions: We found that bupropion improved abstinence over placebo at the end of treatment but that this effect did not persist at 12 months. Because of inconsistent reporting of safety data, the safety profile of bupropion therapy in this patient population remains unclear.