Cytisine for Smoking Cessation (2014)

Smoking cessation remains a critical public health goal, and effective pharmacotherapies are essential. Cytisine, a nicotinic acetylcholine receptor partial agonist, has been used for smoking cessation in Eastern Europe for decades, but its efficacy compared to established therapies like nicotine replacement therapy (NRT) needed robust evaluation.

This was a randomized, controlled, open-label, non-inferiority trial conducted in New Zealand, comparing cytisine to NRT for smoking cessation. Participants were adult smokers randomized to either a 25-day course of cytisine or 8 weeks of NRT, with behavioral support provided to both groups. The primary endpoint was continuous abstinence from smoking at 1 month after the intervention.

Cytisine was found to be superior to NRT for smoking cessation. The continuous abstinence rate at 1 month was 22.1% in the cytisine group compared to 15.3% in the NRT group (relative risk, 1.44; 95% CI, 1.17 to 1.77; P<0.001). Adverse events were more common with cytisine, primarily gastrointestinal symptoms, but serious adverse events were rare and similar between groups.

Cytisine is more effective than NRT for smoking cessation and should be considered a viable, cost-effective pharmacotherapy, particularly where NRT access or cost is a barrier.

The study was open-label, which could introduce bias, and was conducted in a single country, potentially limiting generalizability. The short follow-up for the primary endpoint (1 month) may not fully reflect long-term cessation rates.