A Drug Better Than Nicotine for Smoking Cessation?
A Drug Better Than Nicotine for Smoking Cessation?
Although the study was designed to show noninferiority of oral cytisine versus nicotine replacement, the primary outcome—1 month of continuous nonsmoking—was significantly superior in the cytisine group. It remained so at 6 months when observations ceased.
The potential of this inexpensive smoking cessation modality has been recognized for many years, particularly in Eastern Europe, but has not been pursued despite occasional publications in the West.
Limitations of the present study are that the trial design was open-label, not double-blind. In addition, participants were aware of their treatments and, in the case of nicotine replacement, had to purchase their own treatments, which may well have jeopardized compliance. There was no verification that they were compliant with their treatment, nor verification that they had been abstinent other than their word.
The commercial source of cytisine, sold under the brand name Tabex in the United Kingdom, calls for multiple administrations each day for the first 25 days, a schedule that some patients may have difficulty following.
The long-term efficacy of cytisine remains unknown. However, cytisine appears to be at least as effective as nicotine replacement and possibly more so.
Because of the magnitude of health problems that stem from cigarette smoking worldwide, it would seem that further studies involving long-term use—possibly with a more patient-friendly dosing schedule—would be appropriate if not urgent.
Abstract
Viewpoint
Although the study was designed to show noninferiority of oral cytisine versus nicotine replacement, the primary outcome—1 month of continuous nonsmoking—was significantly superior in the cytisine group. It remained so at 6 months when observations ceased.
The potential of this inexpensive smoking cessation modality has been recognized for many years, particularly in Eastern Europe, but has not been pursued despite occasional publications in the West.
Limitations of the present study are that the trial design was open-label, not double-blind. In addition, participants were aware of their treatments and, in the case of nicotine replacement, had to purchase their own treatments, which may well have jeopardized compliance. There was no verification that they were compliant with their treatment, nor verification that they had been abstinent other than their word.
The commercial source of cytisine, sold under the brand name Tabex in the United Kingdom, calls for multiple administrations each day for the first 25 days, a schedule that some patients may have difficulty following.
The long-term efficacy of cytisine remains unknown. However, cytisine appears to be at least as effective as nicotine replacement and possibly more so.
Because of the magnitude of health problems that stem from cigarette smoking worldwide, it would seem that further studies involving long-term use—possibly with a more patient-friendly dosing schedule—would be appropriate if not urgent.
Abstract