Cytisine Versus Nicotine for Smoking Cessation | Journal Scan

Study Questions:

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


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.


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).


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.


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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