Real-world Effectiveness of Bupropion versus Varenicline for Smoking Cessation: Exploring the Role of Metabolic and Personality Variables

Varenicline and bupropion are efficacious, prescription-only pharmacotherapies for smoking cessation; however, their real-world impact is limited by affordability and accessibility. Using a randomized design, we evaluated the real-world effectiveness of mailed bupropion and varenicline, as well as the roles of nicotine metabolism (NMR) and personality traits, in a sample of interested smokers, utilizing web-based recruitment and follow-up. Quit rates at the end-of-treatment were significantly higher for varenicline (28.3%) compared to bupropion (16.8%). Medication compliance was a significant predictor of quit outcome. NMR was not associated with nicotine dependence, or with quit success with either bupropion or varenicline. Neuroticism (positively) and extraversion (negatively) were significantly correlated with nicotine dependence in men only. Furthermore, in males, conscientiousness and neuroticism were significant predictors of smoking abstinence. Given the low real-world quit rates, improving medication compliance and implementing personalized pharmacological and behavioral interventions are promising approaches to increase effectiveness of tobacco cessation treatments.M.Sc