New Treatment Helped More Patients Ditch Nicotine

Cytisine was cheaper than nicotine replacement therapy and helped more smokers quit

(RxWiki News) If you can fight fire with fire, why not fight addiction to nicotine with another chemical?

The chemical Cytisine (brand names Tabex and Desmoxan) helped more smokers quit than conventional nicotine replacement therapy, a new study found. The authors of this study said side effects were more common with cytisine, however.

These researchers noted that cytisine might be most effective for women who smoke. Women who took cytisine had a higher quit rate than men who took it.

The research team also suggested further research directly comparing cytisine with varenicline (brand name Chantix), another, more expensive smoking-cessation treatment currently in use.

“The trial shows that cytisine is an effective smoking-cessation aid for use as a first-line treatment for tobacco dependence," wrote the study authors, led by Natalie Walker, PhD, of the University of Auckland School of Population Health in New Zealand. "The most common adverse events were nausea and vomiting and sleep disorders."

Smoking has been implicated in chronic medical conditions like heart disease, high blood pressure and lung cancer. Nicotine, a chemical in tobacco, is highly addictive. Patients often find it difficult to stop smoking.

Medications that mimic nicotine’s effects are often used to help people stop smoking. Nicotine-based products in gum, patches and lozenges are often used in smoking cessation. These medications are given in gradually decreasing doses until the smoker is able to abstain completely.

However, conventional tobacco-cessation products are often expensive and out of reach of low-income smokers. Dr. Walker and colleagues noted that the cost of cytisine is about $0.80 a day — compared to more than $5 a day for varenicline.

Dr. Walker and team recruited 1,310 adults who were daily smokers for the trial. The patients had called the New Zealand national smoking quit line for help quitting.

These researchers randomly assigned patients into cytisine or conventional therapy groups of 655 patients each. Women made up 57 percent of each group. The patients were around 38 years old at the time of the study. Most smoked an average of 19 cigarettes a day.

Both groups received low-intensity behavioral support through the smoking quit line. The goal of the trial was to compare cytisine with conventional therapy for smoking cessation and to see which was more effective at one month.

Dr. Walker and team found that 31 percent of the patients on nicotine replacement therapy were able to stop smoking at one month. And 40 percent of the patients on cytisine stopped smoking at one month. Cytisine was also more effective than nicotine replacement therapy at one week, two months and six months.

Dr. Walker's group noted that cytisine was more effective than nicotine replacement therapy in women. Women had a higher quit rate at one month than men who took cytisine.

Side effects were almost twice as common in the cytisine group than in the nicotine replacement group. The primary side effects were nausea, vomiting and sleep disorders.

In an editorial about this study, Nancy A. Rigotti, MD, director of the Tobacco Research and Treatment Center in Boston, said “Cytisine is an inexpensive drug that has been used for decades and for which there are now current data showing its safety and effectiveness. There are millions of smokers worldwide who might benefit from it. The compelling rationale for bringing cytisine to market is not that its efficacy is superior to that of current pharmacotherapies but that current pharmacotherapies are unavailable to so many smokers — especially those in low-income and middle-income countries — because of their cost.”

The study and editorial were published Dec. 17 in the New England Journal of Medicine.

The Health Research Council of New Zealand funded the research. Study author Dr. Hayden McRobbie received lecture fees from Johnson & Johnson and grant support from Pfizer — both pharmaceutical companies.

Review Date: 
December 13, 2014