Smokers who want to quit are more than twice as likely to succeed if they take a pill that dampens nicotine cravings, according to doctors, who said the medicine could play a major role in helping people kick the habit.
Stopping smoking remains one of the most common new year resolutions, but it consistently ranks as one of the hardest to keep, largely because of the highly addictive nature of nicotine.
While many smokers now turn to products that provide nicotine more safely than tobacco, such as vapes, patches and gums, doctors looked at the evidence for a medicine called cytisine to help smokers break their addiction. Cytisine is a natural ingredient in laburnum seeds, however the seeds themselves are poisonous.
Cytisine pills have been safely used in central and eastern Europe for decades, but it is unavailable in most countries, the US included. The drug only recently gained regulatory approval in the UK where the pills will be made available later this month.
Researchers in Argentina analysed 12 randomised controlled trials which compared the success rates of smokers who tried to quit while taking cytisine, a placebo, another smoking cessation drug called varenicline (Champix), or nicotine replacement therapies such as patches and gum.
Cytisine pills were more than twice as effective as the placebo at helping people quit smoking, the researchers found, while a number of the trials in the review suggested the drug was similar to varenicline and possibly more effective than nicotine replacement therapy. Details are published in the journal Addiction.
“Our study adds to the evidence that cytisine is an effective and inexpensive stop-smoking aid,” said Omar de Santi, a toxicologist at the Posadas National hospital in Argentina, who led the review. “Worldwide, smoking is considered the main cause of preventable death. Cytisine has the potential to be one of the big answers to that problem.”
While smoking has declined dramatically in the UK over the past 50 years, it is still the leading cause of preventable illness and death. An estimated 100,000 people each year die due to smoking in the UK, more than the next five largest causes combined, according to the Royal Society for Public Health.
The latest findings follow a major study led by Oxford University in September which concluded that e-cigarettes, varenicline and cytisine were similarly effective in helping about 14 smokers in 100 quit for at least six months. Only about six smokers per 100 quit for as long without using any of the stop-smoking aids, that report found.
Cytisine pills are due to be available in the UK as a prescription-only medicine by the end of January. But the cost, at £115 for a 25-day course of 100 pills, may deter some areas from providing the medicine as part of their health services.
“It is welcome to have a non-nicotine aid to quitting back on the market as some smokers will prefer this,” said Hazel Cheeseman at Action on Smoking and Health (Ash). “However, the decision about whether to include it in stop-smoking services will be local.
“While it is obviously cost effective given the impact on public services of people continuing to smoke, it is currently more expensive than providing nicotine replacement therapy or vapes and some areas may decide not to offer it to smokers.
“Smokers who aren’t able to access this medication straight away should be reassured that using nicotine alternatives is a safe and effective way to quit smoking.”
Robert West, a professor of health psychology and director of tobacco studies at the Cancer Research UK Health Behaviour Research Centre at UCL, said it was “excellent news for smokers” that cytisine was “finally” being approved for sale in the UK.
“It looks like becoming our most important stop-smoking medicine with similar effectiveness to Champix, which is currently unavailable, and e-cigarettes which tend to maintain dependence on nicotine,” he said. “The cost shouldn’t be a deterrent, but it in any event should come down drastically as the market develops and the supplier recoups its outlay in getting marketing approval.”
• This article was amended on 4 January 2024 to note that while cytisine is a natural ingredient in laburnum seeds, the seeds themselves are poisonous, and to clarify that cytisine pills have safely been used for decades to help smokers quit.
