Could Cytisine be the next smoking cessation alternative?

This summary is based on the article published in the New England Journal of Medicine: Cystine versus Nicotine for Smoking Cessation (December 2014)

Natalie Walker, Ph.D., Colin Howe, Ph.D., Marewa Glover, Ph.D., Hayden McRobbie, M.B., Ch.B., Ph.D., Joanne Barnes, Ph.D., Vili Nosa, Ph.D., Varsha Parag, M.Sc., Bruce Bassett, B.A., and Christopher Bullen, M.B., Ch.B., Ph.D.

Context

• Placebo-controlled trials indicate that cytisine, a partial agonist that binds the nicotinic acetylcholine receptor and is used for smoking cessation, almost doubles the chances of quitting at 6 months.
• Cytisine is a plant-based alkaloid found in members of the Leguminosae family.^{1, 2}
• Cytisine is a generic agent currently manufactured by Sopharma as Tabex and by Aflofarm Pharma as Desmoxan. It has been available both with and without prescription for smoking cessation since the 1960s, largely in Eastern Europe.⁵
• Four systematic reviews report cytisine to be superior to placebo for short-term and long-term abstinence.^6-9
• When taken at the recommended dosage (1.5 to 9 mg per day for 25 days), cytisine is associated with no significant increase in adverse events as compared with placebo, although gastrointestinal symptoms are more common. ⁷
• Cytisine remains relatively unknown outside Eastern Europe despite calls for licensing worldwide ^10-12 because of its proven benefits, low cost as compared with other cessation medications.

Purpose of the Study

The authors investigated whether cytisine was at least as effective as nicotine-replacement therapy in helping smokers to quit.

Key Findings

When combined with brief behavioral support, cytisine was found to be superior to nicotine-replacement therapy in helping smokers quit smoking, but it was associated with a higher frequency of self-reported adverse events, including nausea and vomiting and sleep disorders.

References

List of references included in the study (PDF)