Cytisine, a partial agonist of nicotinic acetylcholine receptors, helps smokers quit tobacco more effectively than nicotine-replacement therapy (NRT), according to a New England Journal of Medicine study. The plant-based agent has been used for smoking cessation in Eastern Europe for decades but is largely unavailable elsewhere.

Some 1300 adult daily smokers who were motivated to quit smoking were randomized to receive cytisine tablets for roughly 3.5 weeks or NRT (patches plus gum or lozenges) for 8 weeks. Both groups also received behavioral support via three brief telephone calls over 8 weeks.

The primary outcome — self-reported continuous abstinence at 1 month — was higher with cytisine than with NRT. Similarly, abstinence rates favored cytisine at 2 and 6 months. Cytisine was associated with more adverse events (mostly nausea, vomiting, and sleep disorders), but only 5% of participants discontinued the drug because of side effects.

An editorialist notes that cytisine is inexpensive and, if made widely available, could make smoking cessation pharmacotherapy affordable for many smokers.

NEJM