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Cytisine for smoking cessation

Cytisine for smoking cessation. A literature review and a meta-analysis Jean-François ETTER, PhD Institute of social and preventive medicine University of Geneva - Switzerland E-mail: JFE@JFE.CH August 28, 2006. Background.

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Cytisine for smoking cessation

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  1. Cytisine for smoking cessation A literature review and a meta-analysis Jean-François ETTER, PhD Institute of social and preventive medicine University of Geneva - Switzerland E-mail: JFE@JFE.CH August 28, 2006

  2. Background • Cytisine is found in the seeds of the golden rain tree (Cytisus laburnum). • Cytisine (not to be confounded with cytosine) is an agonist of nicotinic receptors, it binds strongly to alpha4-beta2 nicotinic receptors. • Varenicline is derived from cytisine. • Cytisine has been used to treat tobacco dependence for 40 years in Eastern Europe. • Cytisine is sold as a smoking cessation drug by a Bulgarian firm under the commercial name of Tabex • See www.tabex.net

  3. Objectives • To review the literature on the effect of cytisine on smoking cessation. • To conduct a meta-analysis of placebo-controlled trials.

  4. Data sources • We reviewed: . PubMed, . Embase, . Psychological Abstracts, . Biosis, . Google.com and Scholar.google.com, • Using the keywords cytisine, cytisin, zytisin, cytisinum, Tabex and smoking cessation, and • We contacted experts in several countries and the producer of Tabex. • We obtained professional translations of articles in Polish, Bulgarian, Russian and German

  5. Data synthesis • We found 10 studies reporting on the effects of cytisine on smoking cessation, • Including 4 controlled studies (3 placebo-controlled). • 9 studies used the Bulgarian drug Tabex, containing 1.5 mg cytisine per tablet. • One Russian study used buccal films containing either 1.5 mg cytisine or 0.75 mg cytisine plus 0.75 mg anabasine. • All studies were published between 1967 and 2005 in Bulgaria, Germany, Poland and Russia.

  6. Data synthesis • There were 4427 smokers treated with cytisine and 3518 smokers in control conditions. • The pooled odds ratio after 3-8 weeks in the 3 placebo-controlled trials (two were doubled-blind and one was randomized) was 1.93 (95% CI: 1.21 to 3.06). • For the 2 placebo-controlled, double-blind trials with longer follow-up, the pooled odds ratio after 3-6 months was 1.83 (1.12 to 2.99). • One placebo-controlled, double-blind trial had follow-up after 2 years (odds ratio=1.77, 1.29 to 2.43). • Some side effects were reported.

  7. Meta-analysis of the effect of cytisine versus placebo on smoking cessation at the end of treatment, after 3-8 weeks

  8. Conclusions • Cytisine is very probably effective for smoking cessation. • Studies of poor methodological quality. • This fact remained largely unnoticed in the English-language literature. • How many other effective drugs are there, which remained unnoticed because efficacy trials were never published in English in Western countries? Competing interests: none Funding: none • Paper published as: Cytisine for smoking cessation: a literature review and a meta-analysis. Arch Intern Med. 2006;166:1553-9.

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