Cytisine versus Nicotine for Smoking Cessation

Walker, Natalie; Howe, Colin; Glover, Marewa; McRobbie, Hayden; Barnes, Joanne; Nosa, Vili; Parag, Varsha; Bassett, Bruce; Bullen, Chris

doi:10.1056/nejmoa1407764

Cited by 198 publications

(167 citation statements)

References 28 publications

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“…The absolute sustained long-term quit rates, however, were modest (8.5% for cytisine versus 2.1% for placebo at one year), attributed to the minimal behavioral support provided and the study locales: Poland and Kyrgyzstan, nations still fairly permissive with public tobacco use, where 37% to 45% of men smoke (44). Most recently, an open-label randomized comparative effectiveness trial in New Zealand reported 22% sustained abstinence for cytisine at six months follow-up compared to 15% for NRT patch (RR = 1.4; 1.1–1.8 CI) (45). Reported side effects are primarily gastrointestinal, including abdominal discomfort, dry mouth, dyspepsia, and nausea.…”

Section: Cessation Pharmacotherapymentioning

confidence: 99%

The Past, Present, and Future of Nicotine Addiction Therapy

2016

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The tobacco addiction treatment field is progressing through innovations in medication development, a focus on precision medicine, and application of new technologies for delivering support in real time and over time. This article reviews the evidence for combined and extended cessation pharmacotherapy and behavioral strategies including provider advice, individual counseling, group programs, the national quitline, websites and social media, and incentives. Healthcare policies are changing to offer cessation treatment to the broad population of smokers. With knowledge of the past and present, this review anticipates what is likely on the horizon in the clinical and public health effort to address tobacco addiction.

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Section: Cessation Pharmacotherapymentioning

confidence: 99%

The Past, Present, and Future of Nicotine Addiction Therapy

2016

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“…The only FDA-approved cancer vaccine to date is Provenge, an autologous cell-based therapeutic vaccine against castration-resistant metastatic prostate cancer (65). Although this vaccine was shown to extend survival in prostate cancer patients by 4 months, its implementation is clinically complex, since peripheral blood is first collected from patients, shipped to a cell preparation facility, treated with antigen ex vivo , shipped back to the clinical site, and subsequently re-infused into the patient.…”

Section: Active Depots With Implantable Vaccine Scaffoldsmentioning

confidence: 99%

Engineering New Approaches to Cancer Vaccines

Mehta

Moynihan

Irvine

2015

Cancer Immunology Research

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Recently, a number of promising approaches have been developed using synthetic chemistry, materials science, and bioengineering-based strategies to address challenges in the design of more effective cancer vaccines. At the stage of initial priming, potency can be improved by maximizing vaccine delivery to lymph nodes. Because lymphatic uptake from peripheral tissues is strongly size-dependent, antigens and adjuvants packaged into optimally-sized nanoparticles access the lymph node with much greater efficiency than unformulated vaccines. Once primed, T cells must home to the tumor site. Because T cells acquire the necessary surface receptors in the local lymph node draining the tissue of interest, vaccines must be engineered that reach organs such as the lung and gut, which are common sites of tumor lesions but inaccessible by traditional vaccination routes. Particulate vaccine-carriers can improve antigen exposure in these organs, resulting in greater lymphocyte priming. Immunomodulatory agents can also be injected directly into the tumor site to stimulate a systemic response capable of clearing even distal lesions; materials have been designed that entrap or slowly release immunomodulators at the tumor site, reducing systemic exposure and improving therapeutic efficacy. Finally, lessons learned from the design of biomaterial-based scaffolds in regenerative medicine have led to the development of implantable vaccines that recruit and activate antigen presenting cells to drive anti-tumor immunity. Overall, these engineering strategies represent an expanding toolkit to create safe and effective cancer vaccines.

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“…However, further studies are needed with extended use of cytisine and more intensive behavioural support to evaluate the absolute quit rates and adverse events. In a recent large randomized, controlled trial cytisine for 25 days showed superiority to nicotine patches for 8 weeks after 1 and 6 months [71]. Thus cytisine seems a much cheaper alternative to current pharmacotherapies which are often unavailable to so many smokers -especially those in low-income and middle-income countries [72].…”

Section: Cytisinementioning

confidence: 99%

Pharmacotherapy: Nicotine Replacement Therapy and Other Drugs in Smoking Cessation (Including Vaccination)

Tønnesen¹

2015

The Tobacco Epidemic

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The basic principles in quitting smoking are to set a target quit day and try to cut down to zero cigarettes in a few weeks -but best at target quit day -and then use one of the primary drugs for smoking cessation for 2-3 months. In this period, the ex-smoker has to break the psychological addiction as well as the nicotine dependence. Using one of the primary drugs reduces the withdrawal symptoms. Any support will increase quit rate and counselling should be used in combination with one of the primary drugs, i.e. varenicline, nicotine replacement treatment (NRT) and bupropion SR. Varenicline and the combination of two NRT formulations is equally effective, while varenicline is more effective than either single NRT or bupropion SR. NRTs are especially safe. All three drugs have also been shown to be especially effective in patients with chronic obstructive pulmonary disease and in patients with cardiovascular disorders; the main reason for the larger effect in this subgroup is the low quit rate among placebo-treated subjects. There is extensive and solid scientific proof that underlines the efficacy of these three primary drugs in smoking cessation as well as the very high cost-effectiveness of smoking cessation. Vaccines against nicotine have not been effective until now. © 2015 S. Karger AG, BaselThe aims of this chapter are to summarise the state of the art in smoking cessation with the three first-line drugs, i.e. nicotine replacement therapy (NRT), varenicline and bupropion SR, as well as a short review of the second-line drugs and also the present state of nicotine vaccination. Special focus will be on NRT as NRT is the most used approach for smoking cessation. After reading this chapter, the clinician should have the necessary background information to be able to use and select among the three primary drugs in smoking cessation. Benefits of Smoking CessationLong-term smoking is the main causal reason for chronic obstructive pulmonary disease (COPD) and lung cancer, and to approximately one third of cases of cardiovascular disorders. Compared to never smokers, long-term daily cigarette smoking is associated with higher early mortality from smokinginduced diseases, and ex-smokers have a longer average survival than continuing smokers [1] (see also chapters 7 and 8). Particularly convincing evidence comes from a longitudinal study of UK male doctors who were followed for more than 50 years [1,2]. It was found that the mortality of the smokers was almost double (1.8 times) that of never smokers and that COPD was approximately 13 times more prevalent and lung cancer approximately15 times more prevalent among smokers compared with never smokers. After a 50-year observation, it was concluded that smokers die 10 years younger than non-smokers. Cessation at ages 60, 50, 40 or 30 years gains about 3, 6, 9 or 10 years of life expectancy, respectively. Among UK women, two thirds of all deaths of smokers in their 50s, 60s and 70s are caused by smoking; smokers lose at least 10 years of lifespan [3]. Smoking is also a st...

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Cytisine versus Nicotine for Smoking Cessation

Cited by 198 publications

References 28 publications

The Past, Present, and Future of Nicotine Addiction Therapy

The Past, Present, and Future of Nicotine Addiction Therapy

Engineering New Approaches to Cancer Vaccines

Pharmacotherapy: Nicotine Replacement Therapy and Other Drugs in Smoking Cessation (Including Vaccination)

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