Scanning the Global Literature

cYTISINE VS NIcOTINE FOr SmOkING cESSaTION This randomized, pragmatic, open-labeled trial conducted in New Zealand compared cytisine against nicotine replacement therapy in a sample of 1310 adult daily smokers who had called the national quitline for support. Cytisine is a plant-based alkaloid similar to varenicline and acts on the same nicotinic acetylcholine receptors. Four previous systematic reviews have shown that cytisine is more effective than placebo in both short-term and long-term abstinence, almost doubling the chances of quitting at 6 months. Participants in this study were randomly assigned in a 1:1 ratio to receive cytisine for 25 days at no cost or low-cost nicotine-replacement therapy for 8 weeks, and both groups received behavioral support delivered via the quitline. The primary outcome was self-reported continuous abstinence at 1 month. Cytisine proved more effective than nicotine replacement therapy at 1 week, 1 month, 2 months, and 6 months, although the cytisine group had more selfreported and relatively minor adverse events, mostly nausea, vomiting, and sleep disorders. A planned subgroup analysis showed that cytisine was more effective than nicotine replacement therapy for women compared to men at the primary 1 month point. Limitations of the study included the potential for bias based on the open allocation to treatment, the difference in access to and length of the 2 treatments, the use of self-reported measures, and the study population—quitline callers—may be more motivated to quit than other groups of smokers.