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The effectiveness of Cytisine versus Nicotine Replacement Treatment for smoking cessation in the Russian Federation

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Introduction

Cytisine is a plant-based alkaloid (Webb, 1980; Godley, 2006) that has been marketed as a smoking cessation medication (both with and without a prescription) for more than 50 years in 17 countries within Central and Eastern Europe (Tutka & Zatoński, 2006). Like varenicline, cytisine is a partial agonist of nicotinic acetylcholine receptors (nAChRs) with an affinity for the α4β2 receptor subtype (Coe et al., 2005). However, cytisine differs from varenicline in its pharmacokinetics, cost, and treatment period (Etter, Lukas, Benowitz, West, & Dresler, 2008). Systematic reviews of trial evidence indicate that cytisine is superior to a placebo for achieving short- and long-term abstinence (Cahill, Stead, & Lancaster, 2011; Etter, 2006; Hajek, McRobbie, & Myers, 2013; McRobbie, Hajek, Bullen, & Feigin, 2006). Cytisine is well tolerated when taken at the recommended dosage, although gastrointestinal symptoms and sleep disturbances are more common than when taking a placebo (Hajek et al., 2013).

Nicotine-replacement therapy (NRT) is the most commonly used cessation aid, being available in a variety of forms, such as nicotine gum, inhalers, patches, lozenges, and nasal sprays (available both with and without a prescription) (Aveyard & West, 2007). NRT approximately doubles smoking cessation rates (when used alone and in combination), compared to a placebo (Cahill, Stevens, Perera, & Lancaster, 2013). However, the most effective smoking cessation medication (varenicline) is very expensive (∼US$ 487 for 12 weeks) (Prochaska, Das, & Benowitz, 2013), particularly for Low- and Middle-Income countries (West et al., 2015) where the vast majority of the world’s smokers reside. Cytisine is considered one of the most affordable health‐care interventions to assist tobacco cessation, together with brief advice from a health‐care worker, telephone helplines, automated text messaging, printed self‐help materials, and nortriptyline (West et al., 2015). Despite calls for the licensing of cytisine worldwide, this medication remains unavailable for smoking cessation treatment outside Central and Eastern Europe (Stapleton, 2013; Stapleton & West, 2012; Aveyard & West, 2013).

To date, there have been five placebo-controlled trials which were included in three systematic reviews (Etter, 2006; Cahill et al., 2013; Hajek et al., 2013), all concluding that cytisine is superior to placebo. However, only one comparison trial (Walker et al., 2014) has been conducted to compare the relative effectiveness of cytisine to other smoking cessation medications. This non-inferiority trial, undertaken in New Zealand, found cytisine plus behavioural support to be superior to NRT plus behavioural support in maintaining continuous smoking abstinence for six months (Walker et al., 2014). In order to determine whether this finding is reflected in a real-world population, we analysed data from a cross-sectional study undertaken in the Russian Federation where cytisine has been widely available for many years as an over-the-counter medication (cost: ∼US$6 for 25 days of treatment (West et al., 2011)). We hypothesized that use of cytisine over the past year would be more effective than use of NRT over the past year in the achievement of 30-day and 90-day smoking abstinence rates.

Section snippets

Design

Using cross-sectional data, we compared the self-reported effectiveness in quitting smoking (30-day and 90-day self-reported smoking abstinence) among those who used cytisine and those who used NRT in the last 12 months. The present study is observational in nature and compares cytisine and NRT use in relation to two smoking cessation outcomes among current and previous smokers who tried to quit in the past year. Fig. 1 presents how these groups were created.

Data source

Data were obtained from the 2009

Results

Of the 11,406 people completing the 2009 Russian GATS, a total of 4,807 (42%) respondents stated that they smoked. Of these, 1,403 (29%) had tried to quit smoking in the past year, with 88 (6%) using cytisine in their attempt, and 186 (13%) using NRT (Fig. 1). No significant demographic differences were noted between the two comparison groups (Table 1). Both populations were in their mid-30′s, 60% were male, and four in every five had received a higher education. Just under half in each group

Discussion

This study aimed to compare smoking cessation rates between smokers who used cytisine and NRT, using data from a representative sample of the general population in the Russian Federation in 2009. Whilst there was no difference in 30-day abstinence rates between the two groups, age and gender adjusted 90-day abstinence rates were almost three times higher for people in the cytisine group compared to people using NRT. Although this study was cross-sectional in design, and therefore unable to

Conflict of interest

Dr. Castaldelli-Maia has been awarded with a Pfizer Independent Grant for Learning and Change (IGLC) managed by Global Bridges (Healthcare Alliance for Tobacco Dependence Treatment) hosted at Mayo Clinic, to support free smoking cessation treatment training in addiction/mental health care units in Brazil (grant IGLC 13513957) and Portugal (grant IGLC 25629313), which had no relationship with the present study. Dr. Martins was a consultant for Purdue Pharma to conduct secondary data analyses of

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