Cytisine vs Nicotine for Smoking Cessation


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ABSTRACT

Quit Smoking Drug From Eastern Europe Better Than Nicotine Tx?


Cytisine, a smoking cessation medication available only in Eastern Europe, worked better than conventional nicotine-replacement therapy in a clinical trial.

The drug yielded a 1-month continuous abstinence rate of 40% compared with 31% among quit line callers provided nicotine patches along with gum or lozenges (P<0.001),Natalie Walker, PhD, of the University of Auckland, New Zealand, and colleagues found.

The number needed to treat with cytisine versus was 11, they reported in the New England Journal of Medicine.

The 25-day course of treatment remained superior to 8 weeks of nicotine replacement at the 6-month follow-up on one of the two typical measures of long-term efficacy (continuous abstinence 22% versus 15%, P=0.002).

The 7-day point prevalence of quitting — defined without any allowance for slip-ups, unlike the continuous measure which allows for up to five cigarettes — showed no difference between groups at 6 months.

The Drug

Cytisine is a partial agonist that binds the nicotinic acetylcholine receptor, similar to varenicline (Chantix), and has been on the market — now as a generic — since the 1960s, largely in Eastern Europe.

Its low cost compared with other quit-smoking medications is a big draw, Walker’s group noted. Cytisine sells for $20 to $30 for a 25-day course compared with $112 to $685 for the required 8 to 10 weeks of nicotine replacement therapy and $474 to $501 for a 12-week supply of varenicline.

Nancy A. Rigotti, MD, of the Tobacco Research and Treatment Center at Massachusetts General Hospital and Harvard in Boston, agreed in an editorial accompanying the NEJMpaper.

“The compelling rationale for bringing cytisine to market is not that its efficacy is superior to that of current pharmacotherapies but that current pharmacotherapies are unavailable to so many smokers — especially those in low-income and middle-income countries — because of their cost,” she wrote.

“Stakeholders in high-income countries seeking to contain healthcare costs would also benefit from a lower-cost pharmacotherapeutic option.”

However, getting the drug to the U.S. market could be a challenge, Rigotti told MedPage Today.

The manufacturer in Bulgaria never saw a market for the drug in the U.S. and so never tried for approval, she explained.

“We’re sort of stuck here,” she said in an interview. “We need to find a sponsor for the drug who can take it through the licensing process, but once it went through the licensing process that sponsor would probably make it more expensive. So we might end up with another drug that is just as expensive as others.”

She called instead for “creative collaboration” among regulators, pharma, research funding agencies, and other stakeholders interested in the public health benefit of smoking cessation in order to find some novel pathway through the system for the drug.

Cytisine Trial

The trial findings were likely widely generalizable, Rigotti added

The pragmatic open-label clinical trial used a real-world setting — smokers calling New Zealand’s national telephone quit line wanting to quit — with minimal behavioral support and few exclusion criteria, Rigotti wrote in the editorial. “The advantage of this design is that an intervention found to be truly effective is likely to work in many settings.”

All 1,310 adult daily smokers got an average of three calls of 10 to 15 minutes each from quit line advisers over a period of 8 weeks for behavioral support.

Those randomized to the nicotine-replacement group got vouchers redeemable from community pharmacies for nicotine patches and for gum, lozenges, or both at a cost of about U.S. $2.50 for an 8-week supply of each item.

The cytisine group got their 25-day course of tablets via mail and were instructed to target day five as their quit date. They also got vouchers for nicotine replacement therapy to use if they hadn’t been able to quit by the end of the 25-day course of treatment.

Adverse events were more common with cytisine than with nicotine-replacement therapy, but only 5% of patients stopped taking cytisine because of them.

The side effect profile mirrored that of varenicline, with the most common symptoms being nausea and vomiting and sleep disorders, but without the psychiatric events.

While the study was too small to detect rare events, decades of use of cytisine in Eastern Europe hadn’t turned up psychiatric risks either, Rigotti noted.

The lack of biochemical verification of self-reported tobacco abstinence was a limitation, she cautioned, though, saying further trials would be needed to determine true superiority over nicotine-replacement therapy, as well as to compare cytisine against other first-line pharmacotherapies.

Other Options

Walker’s group had previously reported that electronic cigarettes were at least as good for smoking cessation as were nicotine patches in a similarly-designed pragmatic trial in New Zealand, although neither helped substantially more than placebo.

A Cochrane review by the group, also released Wednesday, found just one other randomized controlled trial to meta-analyze with theirs but also concluded that e-cigarettes help smokers quit.

Electronic cigarettes increased the 6-month quit rate 2.29-fold in the pooled analysis by the most strict criteria — biochemically-verified continuous abstinence (9% versus 4% on placebo).

More people were able to at least halve their conventional cigarette consumption as well (36% versus 27% on placebo, and 61% versus 44% with patch in the one very low quality study).

Neither of the randomized trials and none of the 11 cohort studies reported any serious adverse events considered to be plausibly related to electronic cigarettes.

Hebrew University Researchers Demonstrate Why DNA Breaks Down In Cancer Cells .


black-dna-dna-double-helix-dna-helicase-abstractdna-replication-model-145x88Damage to normal DNA is a hallmark of cancer cells. Although it had previously been known that damage to normal cells is caused by stress to their DNA replication when cancerous cells invade, the molecular basis for this remained unclear.

Now, for the first time, researchers at the Hebrew University of Jerusalem have shown that in early cancer development, cells suffer from insufficient building blocks to support normal DNA replication. It is possible to halt this by externally supplying the “building blocks,” resulting in reduced DNA damage and significant lower potential of the cells to develop cancerous features. Thus, hopefully, this could one day provide protection against cancer development.

In laboratory work carried out at the Hebrew University, Prof. Batsheva Kerem of the Alexander Silberman Institute of Life Sciences and her Ph.D. student Assaf C. Bester demonstrated that abnormal activation of cellular proliferation driving many different cancer types leads to insufficient levels of the DNA building blocks (nucleotides) required to support normal DNA replication.

Then, using laboratory cultures in which cancerous cells were introduced, the researchers were able to show that through external supply of those DNA building blocks it is possible to reactivate normal DNA synthesis, thus negating the damage caused by the cancerous cells and the cancerous potential. This is the first time that this has been demonstrated anywhere.

This work, documented in a new article in the journal Cell, raises the possibility, say the Hebrew University researchers, for developing new approaches for protection against precancerous development, even possibly creating a kind of treatment to decrease DNA breakage.

 

 

argin�C tm�>� �:� ne-height:11.25pt;background: white;vertical-align:baseline’>Furthermore, unlike meats, caffeinated beverages, and alcohol, fruits and vegetables do not improve the taste of cigarettes.

 

“Foods like fruit and vegetables may actually worsen the taste of cigarettes,” remarked Haibach in the statement.

The research team states that more research needs to be done to see if the results can be replicated. If the findings are replicated, the investigators will work to determine the mechanisms in fruit and vegetables that help smokers quit the habit. They also want to look into research based on other dietary factors and smoking cessation.

“It’s possible that an improved diet could be an important item to add to the list of measures to
help smokers quit. We certainly need to continue efforts to encourage people to quit and help them succeed, including proven approaches like quitlines, policies such as tobacco tax increases and smoke-free laws, and effective media campaigns,” concluded researchers in the statement.

 

Source:  redOrbit.com

 

 

 

Ways to quit Smoking..


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An apple a day keeps the doctor away.” New research by public health researchers at the University of Buffalo (UB) reports that eating more fruits and vegetables could help people quit smoking and remain tobacco-free for a longer period of time.

The findings, published in the journal Nicotine and Tobacco Research, are the first in a longitudinal study to look at the effects of eating fruits and vegetables have on those who are participating in smoking cessation programs. The team of researchers surveyed 1,000 smokers who were 25 years of age and older with random-digit dialing telephone interviews. 14 months later, they followed up with the participants and asked if they had stopped using tobacco during the last month.

“Other studies have taken a snapshot approach, asking smokers and nonsmokers about their diets,” explained Dr. Gary A. Giovino, the chair of the Department of Community Health and Health Behavior at UB, in a prepared statement. “We knew from our previous work that people who were abstinent from cigarettes for less than six months consumed more fruits and vegetables than those who still smoked. What we didn’t know was whether recent quitters increased their fruit and vegetable consumption or if smokers who ate more fruits and vegetables were more likely to quit.”

The study showed that smokers who ate the highest amount of fruits and vegetables were three times more likely to stay tobacco-free for a minimum of 30 days during the follow up, more so than those who consumed the least amount of fruits and vegetables. These findings were found consistently among people of different ages, income statuses, genders, races/ethnicities, education, and sexual orientation. Those smokers who ate the most amount of fruits and vegetables also appeared to smoke fewer cigarettes per day, waited a longer amount of time before smoking the first cigarette of the day, and showed to have less dependence on nicotine.

“We may have identified a new tool that can help people quit smoking,” noted Jeffrey P. Haibach, first author on the paper as well as graduate research assistant in the UB Department of Community Health and Health Behavior, in the statement. “Granted, this is just an observational study, but improving one’s diet may facilitate quitting.”

Researchers believe that there are a number of explanations for these results, including the possibility that the higher fiber consumption from fruits and vegetables make people feel less hungry.

“It is also possible that fruits and vegetables give people more of a feeling of satiety or fullness so that they feel less of a need to smoke, since smokers sometimes confuse hunger with an urge to smoke,” explained Haibach in the statement.

Furthermore, unlike meats, caffeinated beverages, and alcohol, fruits and vegetables do not improve the taste of cigarettes.

“Foods like fruit and vegetables may actually worsen the taste of cigarettes,” remarked Haibach in the statement.

The research team states that more research needs to be done to see if the results can be replicated. If the findings are replicated, the investigators will work to determine the mechanisms in fruit and vegetables that help smokers quit the habit. They also want to look into research based on other dietary factors and smoking cessation.

“It’s possible that an improved diet could be an important item to add to the list of measures to
help smokers quit. We certainly need to continue efforts to encourage people to quit and help them succeed, including proven approaches like quitlines, policies such as tobacco tax increases and smoke-free laws, and effective media campaigns,” concluded researchers in the statement.

 

Source:  redOrbit.com

 

Topics: Health Medical PharmaAddictionSmokingTobaccoEthicsHuman behaviorNicotine replacement therapyHealth effects of tobaccoCigarCigaretteNicotineSmoking cessation