Cytisinicline for Smoking Cessation
Importance Cytisinicline (cytisine) is a plant-based alkaloid that, like varenicline, binds selectively to α4β2 nicotinic acetylcholine receptors, which mediate nicotine dependence. Although not licensed in the US, cytisinicline is used in some European countries to aid smoking cessation, but its tr...
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cramacr:10.1001/jama.2023.10042 2024-10-13T14:10:07+00:00 Cytisinicline for Smoking Cessation A Randomized Clinical Trial Rigotti, Nancy A. Benowitz, Neal L. Prochaska, Judith Leischow, Scott Nides, Mitchell Blumenstein, Brent Clarke, Anthony Cain, Daniel Jacobs, Cindy 2023 http://dx.doi.org/10.1001/jama.2023.10042 https://jamanetwork.com/journals/jama/articlepdf/2807079/jama_rigotti_2023_oi_230068_1688654415.02609.pdf en eng American Medical Association (AMA) JAMA volume 330, issue 2, page 152 ISSN 0098-7484 journal-article 2023 cramacr https://doi.org/10.1001/jama.2023.10042 2024-09-17T04:04:26Z Importance Cytisinicline (cytisine) is a plant-based alkaloid that, like varenicline, binds selectively to α4β2 nicotinic acetylcholine receptors, which mediate nicotine dependence. Although not licensed in the US, cytisinicline is used in some European countries to aid smoking cessation, but its traditional dosing regimen and treatment duration may not be optimal. Objective To evaluate the efficacy and tolerability of cytisinicline for smoking cessation when administered in a novel pharmacokinetically based dosing regimen for 6 or 12 weeks vs placebo. Design, Setting, and Participants A 3-group, double-blind, placebo-controlled, randomized trial (ORCA-2) compared 2 durations of cytisinicline treatment (6 or 12 weeks) vs placebo, with follow-up to 24 weeks, among 810 adults who smoked cigarettes daily and wanted to quit. It was conducted at 17 US sites from October 2020 to December 2021. Interventions Participants were randomized (1:1:1) to cytisinicline, 3 mg, 3 times daily for 12 weeks (n = 270); cytisinicline, 3 mg, 3 times daily for 6 weeks then placebo 3 times daily for 6 weeks (n = 269); or placebo 3 times daily for 12 weeks (n = 271). All participants received behavioral support. Main Outcomes and Measures Biochemically verified continuous smoking abstinence for the last 4 weeks of cytisinicline treatment vs placebo (primary) and from end of treatment to 24 weeks (secondary). Results Of 810 randomized participants (mean age, 52.5 years; 54.6% female; mean of 19.4 cigarettes smoked daily), 618 (76.3%) completed the trial. For the 6-week course of cytisinicline vs placebo, continuous abstinence rates were 25.3% vs 4.4% during weeks 3 to 6 (odds ratio [OR], 8.0 [95% CI, 3.9-16.3]; P < .001) and 8.9% vs 2.6% during weeks 3 to 24 (OR, 3.7 [95% CI, 1.5-10.2]; P = .002). For the 12-week course of cytisinicline vs placebo, continuous abstinence rates were 32.6% vs 7.0% for weeks 9 to 12 (OR, 6.3 [95% CI, 3.7-11.6]; P < .001) and 21.1% vs 4.8% during weeks 9 to 24 (OR, 5.3 [95% CI, 2.8-11.1]; ... Article in Journal/Newspaper Orca AMA JAMA 330 2 152 |
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Importance Cytisinicline (cytisine) is a plant-based alkaloid that, like varenicline, binds selectively to α4β2 nicotinic acetylcholine receptors, which mediate nicotine dependence. Although not licensed in the US, cytisinicline is used in some European countries to aid smoking cessation, but its traditional dosing regimen and treatment duration may not be optimal. Objective To evaluate the efficacy and tolerability of cytisinicline for smoking cessation when administered in a novel pharmacokinetically based dosing regimen for 6 or 12 weeks vs placebo. Design, Setting, and Participants A 3-group, double-blind, placebo-controlled, randomized trial (ORCA-2) compared 2 durations of cytisinicline treatment (6 or 12 weeks) vs placebo, with follow-up to 24 weeks, among 810 adults who smoked cigarettes daily and wanted to quit. It was conducted at 17 US sites from October 2020 to December 2021. Interventions Participants were randomized (1:1:1) to cytisinicline, 3 mg, 3 times daily for 12 weeks (n = 270); cytisinicline, 3 mg, 3 times daily for 6 weeks then placebo 3 times daily for 6 weeks (n = 269); or placebo 3 times daily for 12 weeks (n = 271). All participants received behavioral support. Main Outcomes and Measures Biochemically verified continuous smoking abstinence for the last 4 weeks of cytisinicline treatment vs placebo (primary) and from end of treatment to 24 weeks (secondary). Results Of 810 randomized participants (mean age, 52.5 years; 54.6% female; mean of 19.4 cigarettes smoked daily), 618 (76.3%) completed the trial. For the 6-week course of cytisinicline vs placebo, continuous abstinence rates were 25.3% vs 4.4% during weeks 3 to 6 (odds ratio [OR], 8.0 [95% CI, 3.9-16.3]; P < .001) and 8.9% vs 2.6% during weeks 3 to 24 (OR, 3.7 [95% CI, 1.5-10.2]; P = .002). For the 12-week course of cytisinicline vs placebo, continuous abstinence rates were 32.6% vs 7.0% for weeks 9 to 12 (OR, 6.3 [95% CI, 3.7-11.6]; P < .001) and 21.1% vs 4.8% during weeks 9 to 24 (OR, 5.3 [95% CI, 2.8-11.1]; ... |
format |
Article in Journal/Newspaper |
author |
Rigotti, Nancy A. Benowitz, Neal L. Prochaska, Judith Leischow, Scott Nides, Mitchell Blumenstein, Brent Clarke, Anthony Cain, Daniel Jacobs, Cindy |
spellingShingle |
Rigotti, Nancy A. Benowitz, Neal L. Prochaska, Judith Leischow, Scott Nides, Mitchell Blumenstein, Brent Clarke, Anthony Cain, Daniel Jacobs, Cindy Cytisinicline for Smoking Cessation |
author_facet |
Rigotti, Nancy A. Benowitz, Neal L. Prochaska, Judith Leischow, Scott Nides, Mitchell Blumenstein, Brent Clarke, Anthony Cain, Daniel Jacobs, Cindy |
author_sort |
Rigotti, Nancy A. |
title |
Cytisinicline for Smoking Cessation |
title_short |
Cytisinicline for Smoking Cessation |
title_full |
Cytisinicline for Smoking Cessation |
title_fullStr |
Cytisinicline for Smoking Cessation |
title_full_unstemmed |
Cytisinicline for Smoking Cessation |
title_sort |
cytisinicline for smoking cessation |
publisher |
American Medical Association (AMA) |
publishDate |
2023 |
url |
http://dx.doi.org/10.1001/jama.2023.10042 https://jamanetwork.com/journals/jama/articlepdf/2807079/jama_rigotti_2023_oi_230068_1688654415.02609.pdf |
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JAMA volume 330, issue 2, page 152 ISSN 0098-7484 |
op_doi |
https://doi.org/10.1001/jama.2023.10042 |
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JAMA |
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330 |
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152 |
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