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Acute Coronary SyndromePhase 3ZESCANCT00689611

Zyban as an Effective Smoking Cessation Aid for Patients Following an Acute Coronary Syndrome: The ZESCA Trial

A Phase 3 study testing Bupropion HCl ER in people with Acute Coronary Syndrome and Myocardial Infarction, run by Mark Eisenberg at 38 sites in 7 countries.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Patients who continue to smoke after a heart attack have a 35% increased risk of a recurrent event or death compared with those who quit. Many patients attempt to stop smoking after a heart attack, but relapse rates approach 66%. Read more about this study

Who is it for?
Ages 18 years and older
What is being tested?
Bupropion HCl ER
Type of treatment
Pill or oral medicine
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
392 participants
Where
38 sitesin 7 countries
Study dates
Dec 2005to Jun 2010
Phase
Phase 3
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • ≥ 18 years of age
  • Smoke at least 10 cigarettes/day for the past year
  • Suffered an enzyme-positive ACS
  • Planned hospitalization of ≥24 hours
  • Motivated to quit smoking
  • Likely to be available for follow-up
  • Able to understand and read English or French

Who cannot join

  • Medical condition with a prognosis of < 1 year
  • Pregnant or lactating
  • Current use of Wellbutrin or any other medications that contain bupropion
  • Current use of any medical therapy for smoking cessation (e.g. BuSpar, fluoxetine, doxepin, nicotine gum, or nicotine patch)
  • Current seizure disorder, history of seizures or predisposition to seizures (e.g. history of brain tumor, severe head trauma, or stroke)
  • History of bulimia or anorexia nervosa
Show all 15Show fewer
  • Current diagnosis of major depression (requiring medication), bipolar disease, or dementia
  • History of suicidal events (previous suicide attempt, suicidal ideation) or family history of suicide
  • Diagnosed hepatic failure, cirrhosis, hepatitis or history of hepatic impairment (AST or ALT levels ≥ 2 times upper limit of normal prior to admission for ACS)
  • Renal impairment with creatinine levels ≥ 2 times the upper limit of normal
  • Excessive alcohol consumption defined as ≥ 14 alcoholic drinks per week
  • Use of any illegal drugs in the past year (e.g. cocaine, heroin, opiates)
  • Current use of medications that lower seizure threshold e.g. amantadine, anti-depressants, anti-malarials, anti-psychotics, levodopa, lithium, quinolone antibiotics, ritonavir, systemic steroids, theophyllin, type 1C antiarrhythmics (e.g. encainide, flecainide, propafenone)
  • Use of MAO inhibitors or thioridazine in the past 15 days
  • Current use of over-the-counter stimulants (e.g. ephedrine, phenylephrine) or anoretics

Trial locations and contacts

38 sites in 7 countries.

38 sites in 7 countries

Canada20 sites
  • Peter Lougheed Centre of the Calgary General Hospital

    Calgary, Alberta

  • University of Alberta Hospital

    Edmonton, Alberta

  • Valley Regional Hospital

    Kentville, Nova Scotia

  • Hopital de la Cite de la Sante

    Laval, Quebec, H7M 3L9

  • CHA Hotel-Dieu de Levis

    Lévis, Quebec

  • SMBD- Jewish General Hospital

    Montreal, Quebec, H3T 1E2

  • Hopital Sacre-Coeur de Montreal

    Montreal, Quebec

  • Hotel-Dieu

    Montreal, Quebec

  • Montreal General Hospital

    Montreal, Quebec

  • The Ottawa Hospital, General Campus

    Ottawa, Ontario

  • Hopital Laval

    Québec, Quebec, G1V 4G5

  • New Brunswick Heart Centre

    Saint Johns, New Brunswick

  • Saskatchewan Drug Research Institute

    Saskatoon, Saskatchewan, S7N 0W8

  • Hopital Fleurimont

    Sherbrooke, Quebec, J1H 5N4

  • CSSS de Sorel-Tracy

    Sorel-Tracy, Quebec

  • CSSS de la Region de Thetford

    Thetford-Mines, Quebec

  • St. Michael's Hospital

    Toronto, Ontario

  • Vancouver Coastal Health

    Vancouver, British Columbia, V5M 1L9

  • Victoria General Hospital

    Winnipeg, Manitoba, R3T 2E8

  • St. Boniface General Hospital

    Winnipeg, Manitoba

Other trials in Canada

United States13 sites
  • Bay Regional Medical Center

    Bay City, Michigan

  • Medical University of South Carolina

    Charleston, South Carolina, 29403

  • Bassett Healthcare

    Cooperstown, New York, 13326

  • United Health Services

    Johnson City, New York, 13790

  • Schuster Cardiology

    Kettering, Ohio, 45429

  • Southwest Cardiology

    Kettering, Ohio, 45429

  • Central Maine Medical Center

    Lewiston, Maine, 04240

  • Riverside Hospital

    Newport News, Virginia, 23601

  • DVA Medical Center

    Oklahoma City, Oklahoma, 73104

  • Parkview Medcial Center

    Pueblo, Colorado, 81003

  • Advanced Cardiology Specialists

    Scranton, Pennsylvania, 18501

  • Charleston Area Medical Center

    South Charleston, West Virginia, 25309

  • Stony Brook Hospital and Medical Center

    Stony Brook, New York, 11794-8167

Other trials in United States

Bangladesh1 site
  • National Heart Foundation of Bangladesh

    Dhaka

Other trials in Bangladesh

India1 site
  • Centre for Chronic Disease Control

    New Delhi

Other trials in India

Iran1 site
  • Isfahan Cardiovascular Research Centre

    Isfahan, Iran

Other trials in Iran

Pakistan1 site
  • InterActive Research and Development

    Karachi

Other trials in Pakistan

Tunisia1 site
  • University Hospital F. Bourguiba

    Sousse, Sousse Governorate

Other trials in Tunisia

About this study

Patients who continue to smoke after a heart attack have a 35% increased risk of a recurrent event or death compared with those who quit. Many patients attempt to stop smoking after a heart attack, but relapse rates approach 66%. A variety of smoking cessation aids have been shown to be effective for the general population. However, bupropion is the only non-nicotine replacement therapy shown to improve abstinence rates in healthy young smokers. Furthermore, nicotine replacement therapies (NRTs) are contraindicated in the immediate period following a heart attack because of the undesirable effects of nicotine. Although bupropion has been successfully used to reduce smoking rates in healthy young populations, its efficacy and safety in the setting of patients recovering from an ACS is unknown. These patients, if they continue to smoke, are at exceptionally high risk for recurrent cardiac events. If bupropion is effective in this population, it will have a major impact on secondary prevention of recurrent clinical events in patients who suffer a heart attack.

Read the detailed description

Patients who continue smoking after ACS have a 35% increased risk of reinfarction or death compared with those who quit. Many patients attempt to stop smoking after an acute coronary syndrome (ACS), but relapse rates approach 66%. A variety of smoking cessation aids have been shown to be effective for the general population. However, physicians are reluctant to use a nicotine-based therapy because of its hemodynamic effects. Bupropion is the only non-nicotine replacement therapy shown to improve abstinence rates in healthy young smokers by approximately 50%. Although bupropion has successfully been used to reduce smoking rates in healthy young populations, its efficacy and safety in the setting of patients recovering from an ACS is unknown.

The ZESCA Trial will directly compare the efficacy and safety of bupropion versus placebo as a means of reducing smoking rates in patients following an ACS. The ZESCA Trial will be a multi-center effort, coordinated from the Jewish General Hospital/McGill University (Montreal, Quebec). A total of 1500 patients will be randomized following an ACS but before hospital discharge via an Internet web site. Prior to the start of the treatment, patients in both treatment arms will receive a standard physician-administered counseling session regarding smoking cessation. Patients will begin treatment in-hospital and will be monitored in-hospital for ≥ 2 days prior to discharge. Half the patients will receive bupropion for 9 weeks and the other half will receive placebo pills for 9 weeks. Patients receiving bupropion will take 150 mg once per day for 3 days and then 150 mg twice per day for the remainder of 9 weeks. Prior to discharge, the patients will receive an information sheet listing the possible side effects of bupropion. They will be advised to consult the treating physician should they experience any listed side effects. While in-hospital, patients will have quit smoking and they will be instructed to not restart smoking when discharged. Phone calls to the patients will be made by the study nurses at weeks 1 and 2 of the 9-week treatment period. In addition, the patients will have clinic visits at weeks 4 and 9 as well as months 6 and 12. Smoking abstinence will be assessed at 4 weeks, 9 weeks, 6 months, and 12 months after randomization. Smoking abstinence will be defined as the complete abstinence in the week prior to the clinic visits and levels of exhaled carbon monoxide ≤ 10 ppm. Side effects of bupropion in patients following ACS as well as clinical events following initiation of treatment will be measured at weeks 1-8 (by telephone calls), and weeks 4 and 9 as well as months 6 and 12 (by clinic visits). Withdrawal symptoms will also be assessed by the nurses during their weekly calls.

Trials previously conducted with bupropion involved young healthy smokers. The ZESCA trial will be the first to examine the utility of bupropion in a group of patients with an ACS. These patients, if they continue to smoke, are at exceptionally high risk for recurrent cardiac events. If bupropion is effective in this population, it will have a major impact on secondary prevention of recurrent clinical events in patients who suffer an ACS.

Being tested
Bupropion HCl ER, Placebo
Keywords
Acute coronary syndrome, Myocardial infarction, Smoking cessation, Zyban, Secondary intervention post-ACS
Medical subject headings
Acute Coronary Syndrome, Myocardial Infarction, Smoking, Smoking Cessation

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Bupropion HCl ERDrug

    Also called Zyban

    150 mg tablets po qd for 3 days and then 150 mg po bid for remainder of 9 weeks

  • PlaceboDrug

    Placebo

Study groups in NCT00689611
Study groupRoleWhat they receive
PPlacebo comparatorHalf of patients will receive placebo for 9 weeks.
Receives: Drug: Placebo
AActive comparatorHalf of patients will receive bupropion for 9 weeks.
Receives: Drug: Bupropion HCl ER

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Smoking Abstinence

    The primary end point was 7-day point prevalence smoking abstinence at 12 months. Smoking cessation was defined as self-reported abstinence in the week before the 12-month clinic visit and a measurement of exhaled carbon monoxide less than 11 ppm.

    The primary end point was analyzed on an intention-to-treat (ITT) basis. Our ITT analysis assumed that those who withdrew consent or were lost to follow-up had returned to smoking at their baseline rates. This assumption is common in smoking cessation trials.

    Measured: 12 months

Secondary outcomes (1)
  1. Composite Major Adverse Cardiovascular Events (MACE)

    All clinical end points were adjudicated by members of the Endpoints Evaluation Committee who were blinded to treatment assignment.

    Composite MACE (death, myocardial infarction, unstable angina)

    Measured: 12 months

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted3 Jun 2008 (estimated)
  2. Study startDec 2005
  3. Primary completionJun 2010
  4. Study completionJun 2010

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 3
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Quadruple blind
Who is masked
Participant, Care provider, Investigator, Outcomes assessor
Enrolment
392 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT00689611
Sponsor's protocol ID
ZESCA 9197
Other IDs
ISRCTN75356261
Acronym
ZESCA
Status last verified
Apr 2015
First submitted
30 May 2008
Last updated
23 Apr 2015
Data monitoring committee
Yes

Publications

  • Hajizadeh A, Howes S, Theodoulou A, Klemperer E, Hartmann-Boyce J, Livingstone-Banks J, Lindson N. Antidepressants for smoking cessation. Cochrane Database Syst Rev. 2023 May 24;5(5):CD000031. doi: 10.1002/14651858.CD000031.pub6.

    PubMed 37230961
  • Hartmann-Boyce J, Theodoulou A, Farley A, Hajek P, Lycett D, Jones LL, Kudlek L, Heath L, Hajizadeh A, Schenkels M, Aveyard P. Interventions for preventing weight gain after smoking cessation. Cochrane Database Syst Rev. 2021 Oct 6;10(10):CD006219. doi: 10.1002/14651858.CD006219.pub4.

    PubMed 34611902
  • Taylor GM, Lindson N, Farley A, Leinberger-Jabari A, Sawyer K, Te Water Naude R, Theodoulou A, King N, Burke C, Aveyard P. Smoking cessation for improving mental health. Cochrane Database Syst Rev. 2021 Mar 9;3(3):CD013522. doi: 10.1002/14651858.CD013522.pub2.

    PubMed 33687070
  • Zhang DD, Eisenberg MJ, Grandi SM, Joseph L, O'Loughlin J, Paradis G, Lozano P, Filion KB. Bupropion, smoking cessation, and health-related quality of life following an acute myocardial infarction. J Popul Ther Clin Pharmacol. 2014;21(3):e346-56. Epub 2014 Oct 8.

    PubMed 25326910
  • Shimony A, Grandi SM, Pilote L, Joseph L, O'Loughlin J, Paradis G, Rinfret S, Sarrafzadegan N, Adamjee N, Yadav R, Gamra H, Diodati JG, Eisenberg MJ; ZESCA Investigators. Utilization of evidence-based therapy for acute coronary syndrome in high-income and low/middle-income countries. Am J Cardiol. 2014 Mar 1;113(5):793-7. doi: 10.1016/j.amjcard.2013.11.024. Epub 2013 Dec 12.

    PubMed 24440324

Questions about this trial

What is this clinical trial studying?

A Phase 3 study testing Bupropion HCl ER in people with Acute Coronary Syndrome and Myocardial Infarction, run by Mark Eisenberg at 38 sites in 7 countries.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 7 inclusion and 15 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 23 Apr 2015. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 38 sites in Canada, United States, Bangladesh, India, Iran and 2 more countries. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

Yes. Results are posted in the registry (first posted 23 Apr 2015). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Smoking Abstinence (time frame: 12 months). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT00689611, which also lists 5 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 23 Apr 2015.

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