Topiramate for Smoking Cessation: A Randomized, Placebo-Controlled, Pilot Study
Mené auprès de 57 fumeurs, cet essai randomisé évalue l'efficacité du topiramate (un inhibiteur des récepteurs du glutamate), seul ou en combinaison avec un patch nicotinique, pour arrêter le tabagisme
Introduction : Topiramate (TOP) blocks glutamate receptors and facilitates GABA (
γ-aminobutyric acid), neurotransmission, effects that may facilitate smoking cessation. We compared the effects of behavioral counseling combined with (a) TOP, (b) TOP/nicotine patch (TOP/NIC), or (c) placebo (PLC) for smoking cessation.
Methods
: We conducted a 10-week randomized trial in which subjects and research personnel were blinded to TOP versus PLC but not to the TOP/NIC patch condition. In groups receiving TOP, the medication dosage was titrated gradually up to 200mg/day. The smoking quit date (QD) was scheduled after 2 weeks of medication treatment. NIC (21mg) was started on the QD in subjects randomized to the TOP/NIC condition. The main outcome measure was the end-of-treatment, 4-week continuous abstinence rate (CAR; biochemically confirmed).
Results
: Fifty-seven subjects were randomized to treatment. The 4-week CAR was 1 of 19 (5%) in the PLC group, 5 of 19 (26%) in the TOP group, and 7 of 19 (37%) in the TOP/NIC group (p = .056). Pairwise comparisons showed a difference between TOP/NIC and PLC (p = .042) and a nonsignificant difference between TOP and PLC (p = .18). The PLC group gained 0.37 lb/week, the TOP group lost 0.41 lb/week, and the TOP/NIC group lost 0.07 lb/week (p = .004). Pairwise comparisons showed a difference between TOP and PLC (p < .001) and between TOP/NIC and PLC groups (p = .035). Paresthesia was more frequent in subjects on TOP than PLC (p = .011).
Conclusions
: TOP, alone or in combination with the NIC, resulted in a numerically higher quit rate than PLC and decreased weight. A larger, PLC-controlled trial is needed to confirm these findings.
Nicotine & Tobacco Research , résumé, 2013