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Cheap Drug Helps Smokers Quit, Study Finds
Date:9/29/2011

By Steven Reinberg
HealthDay Reporter

WEDNESDAY, Sept. 28 (HealthDay News) -- For people trying to quit smoking, the drug cytisine works better than a placebo, and its comparatively low cost makes it an appealing alternative to newer stop-smoking medications, researchers say.

Over the course of a year, researchers found cytisine, a nicotine substitute, more effective than a placebo in helping smokers stop the habit, and the researchers said its affordability could be an advantage in poorer countries.

"Many smokers can stop without help, but many are addicted and will continue until they die unless they get help," said lead researcher Robert West, from the Health Behaviour Research Center at University College London in England.

"The key feature of this drug is that it is extremely cheap and so affordable by just about anyone in the world who can afford to smoke," he added.

Cytisine, sold as Tabex in former socialist economy countries for four decades, has now been shown to be an effective and safe way of helping smokers quit, West added. But it does not have U.S. Food and Drug Administration approval, so it is not available in the United States.

The drug is extracted from the Cytisus laborinum L. (Golden Rain acacia) plant, and as a smoking-cessation aid it is similar to nicotine replacement drugs such as Chantix, patches and gums.

In Poland, where the study was done, cytisine costs $15 for a course of treatment, the researchers noted. In China, an 8-week course of nicotine-replacement therapy costs $230; an 8-week course of Zyban (bupropion) costs $123 and a 12-week course of Chantix (vareniclene) costs $327, while a pack of cigarettes typically costs 73 cents and sometimes much less, they said.

"Cytisine could save many thousands of lives, particularly in low- and middle-income countries," West said. "But it could also save health care systems and insurers in high-income countries millions on their drugs bill."

About 5 million people globally die prematurely from smoking each year, the study authors noted.

The study, published in the Sept. 29 issue of the New England Journal of Medicine, was largely paid for by Britain's publicly funded National Prevention Research Initiative.

For the study, West's team randomly assigned 740 smokers to cytisine or a placebo for 25 days. In addition, the participants received minimal counseling to help them quit. More than 80 percent of participants had already tried to quit.

After one year, 8.4 percent of those who had taken cytisine were still not smoking, compared with 2.4 percent of those who received the placebo, the researchers found.

Adverse side effects occurred more often in those receiving cytisine and included stomach ache, dry mouth, difficulty breathing and nausea. But, these were generally mild and not long lasting, the authors noted.

Commenting on the study, Dr. Michael C. Fiore, a professor of medicine and director of the Center for Tobacco Research and Intervention at the University of Wisconsin School of Medicine and Public Health in Madison, said that "the findings are encouraging and promising, but need to be replicated."

Around the world there are about one billion smokers, Fiore said. "Many of them want to quit, but don't have access to the counseling we know would help, and many of the medicines are too expensive for them to purchase," he said.

"If there is a medication that is safe, effective and inexpensive, it would be an important advance," he added. However, the results of this study need to be replicated in other groups to ensure that it is both safe and effective before cytisine can be considered such a drug, he said.

Another expert, Dr. Steven Schroeder, director of the Smoking Cessation Leadership Center at the University of California, San Francisco, added that "if cytisine comes on the market in the U.S. and it's cheap, that's great."

Schroeder said if people in a trial of cytisine were to receive as much counseling as they do in trials of other drugs, such as Zyban and Chantix, and if treatment was longer, then similar quit rates of 15 to 25 percent would be seen.

"I think you would see better results," he said.

More information

For more information on quitting smoking, visit SmokeFree.gov.

SOURCES: Robert West, Ph.D., Health Behaviour Research Center, University College London, England; Michael C. Fiore, M.D., M.P.H., professor of medicine, director, Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison; Steven Schroeder, M.D., director, Smoking Cessation Leadership Center, University of California, San Francisco; Sept. 29, 2011, New England Journal of Medicine


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