One-year comparative effectiveness of bupropion and nicotine replacement therapy in smoking cessation: A prospective observational cohort study in Turkey.

Objective: Based on randomized clinical trials, bupropion and nicotine replacement therapy (NRT) are recommended as equally effective first-line pharmacotherapies for smoking cessation. However, long-term real-world observational data comparing these two treatment options are scarce. This study aimed to evaluate 12 months smoking cessation success rates among adult smokers attending a community health center-affiliated Smoking Cessation Clinic in Giresun, Turkey, comparing bupropion with nicotine replacement therapy (NRT) in a real-world clinical setting. Methodology: This prospective observational cohort study included 235 adult smokers who visited a single-center, community health center-affiliated Smoking Cessation Clinic in Giresun, Turkey, between October 2022 and October 2023. All participants received physician-led counseling and were prescribed either bupropion (n=45) or NRT (n=190; NRT 15 mg, n=118, and NRT 25 mg, n=72). Both treatments were provided free of charge for 12 weeks, during which six scheduled clinical visits were conducted over a 90-day period. Telephone follow-up assessments were conducted at weeks 16, 24 and 52. The primary outcome was the self-reported continuous abstinence at week 52. Results: The mean age of participants was 40.74 ± 12.42 years, with 59.6% (n=140) being men. The overall 12 months continuous abstinence rate was 69.4% (n=163). The independent predictors of sustained abstinence at 52 weeks were high adherence to treatment, regular attendance at scheduled follow-up visits, counseling along with bupropion or high-dose NRT (25 mg), and fewer adverse effects during treatment. Conclusion: In real-world clinical practice, bupropion or high-dose NRT (25 mg), combined with structured counseling yielded high long-term abstinence rates and acceptable side effect profiles.