"Cytisine versus Nicotine-Replacement Therapy for Smoking Cessation"
Links to original sources: Wiki Journal Post Full Journal Article
Does cytisine provide a superior alternative to nicotine-replacement therapy in assisting smokers to quit smoking?
Cytisine is superior to nicotine-replacement therapy in helping smokers quit smoking and shows higher one-month continuous abstinence rates, but it is associated with more frequent self-reported adverse events.
Cytisine, a plant-based alkaloid, is a partial agonist at nicotinic acetylcholine receptors and has been used for smoking cessation primarily in Eastern Europe since the 1960s. Previous research suggested cytisine's effectiveness in smoking cessation, but no direct comparisons with nicotine-replacement therapy had been conducted. This pragmatic, open-label, noninferiority trial in New Zealand provided strong evidence that cytisine, when combined with behavioral support, is superior to nicotine-replacement therapy in achieving smoking cessation at various time points, despite more commonly reported adverse events.
The study results suggest cytisine as a cost-effective, first-line treatment for tobacco dependence, considering its superior efficacy in comparison to nicotine-replacement therapy. Further studies may influence future guidelines regarding its broader use.
A pragmatic, open-label, noninferiority randomized controlled trial with 1,310 adult daily smokers who were motivated to quit, allocated either to cytisine for 25 days or nicotine-replacement therapy for 8 weeks.
The study included adult daily smokers, with baseline characteristics such as demographics, smoking history, medication, motivation to quit and dependence on cigarettes being evenly balanced between treatment groups.
Participants received either cytisine by mail or nicotine-replacement therapy through vouchers. Both groups were also provided low-intensity, telephone-delivered behavioral support.
The primary outcome was self-reported continuous abstinence at 1 month. Secondary outcomes included self-reported continuous abstinence at 1 week, 2 months, and 6 months, as well as self-reported adverse events.
- Unblinded nature of the study could introduce reporting bias, particularly in the reporting of adverse events. - Verification of self-reported abstinence was not conducted. - Duration of follow-up might not capture long-term adverse events and sustained efficacy.
The study was funded by the Health Research Council of New Zealand.
The full study report is published in the New England Journal of Medicine, with the trial registered on the Australian New Zealand Clinical Trials Registry.