Cytisine Versus Nicotine for Smoking Cessation | Journal Scan

Study Questions:

Is cytisine as effective as nicotine-replacement therapy for smoking cessation?

Methods:

This was an open-label noninferiority trial conducted in New Zealand. Adult daily smokers who reported being motivated to quit and had called the national quit line were included. Participants were randomized (in a 1:1 ratio) to cytisine for 25 days or nicotine-replacement therapy for 8 weeks. Low-intensity, telephone-delivered behavioral support was provided to both groups through the quit line. The primary outcome was self-reported continuous abstinence at 1 month.

Results:

A total of 1,310 adults were included in this trial. At 1 month, continuous abstinence from smoking was reported for 40% of participants receiving cytisine (264 of 655) and 31% of participants receiving nicotine-replacement therapy (203 of 655), for a difference of 9.3 percentage points (95% confidence interval, 4.2-14.5).The effectiveness of cytisine for continuous abstinence was also superior to that of nicotine-replacement therapy at 1 week, 2 months, and 6 months. Cytisine was superior to nicotine-replacement therapy among women and noninferior among men. Self-reported adverse events (primarily nausea/vomiting and sleep disorders) over 6 months occurred more frequently in the cytisine group (288 events among 204 participants) than in the group receiving nicotine-replacement therapy (174 events among 134 participants).

Conclusions:

The investigators concluded that 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.

Perspective:

These data suggest that cytisine may be an effective treatment for smoking cessation, particularly among women. However, confirmation of these results and verification of smoking abstinence, including long-term abstinence, is warranted.

Keywords: Alkaloids, Azocines, Nausea, New Zealand, Nicotine, Quinolizines, Sleep Disorders, Smoking Cessation, Telephone, Tobacco Use, Vomiting


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