BACKGROUND: As a nicotine receptor partial agonist, cytisine could be used to help people to stop both smoking and vaping.
METHODS: We reviewed Cochrane reviews to provide an overview of trial evidence on cytisine for smoking and vaping cessation. We analyzed cross-country evidence from the International Tobacco Control (ITC) survey on the use of cytisine.
RESULTS: Cochrane systematic reviews have investigated cytisine for smoking and vaping cessation through meta-analysis of randomized controlled trials. This includes comparisons with placebo, no treatment, and with other smoking cessation treatments, via pairwise and component network meta-analyses, showing promising findings related to smoking and vaping outcomes, as well as safety and tolerability. Trial evidence can indicate efficacy and safety, but other questions remain about real-world use. Using data from the 2022 ITC Four Country Smoking and Vaping Survey, we estimated prevalence of cytisine and other smoking cessation medications (NRT, varenicline/bupropion) used by adults (aged ≥18) at their most recent attempt to quit smoking cigarettes in the past 2 years in Australia(n=599), Canada(n=740), England(n=668), and US(n=638). Among adults who smoked ≥weekly (n=1790) or quit smoking ≤2 years (n=855), 0.4% used cytisine (country main effect:p=0.09): highest in England (0.8%) and lowest in the US (0.1%), 26.3% used NRT (country:p=0.01); highest in Australia (32.9%) and lowest in the US (20.6%); 9.5% used varenicline/bupropion (country:p=.09): highest in the US (12.2%) and lowest in England (6.2%).
CONCLUSIONS: Despite promising trial and systematic review evidence, use of smoking cessation medications was low in all four ITC countries studied. Cytisine was rarely used, demonstrating that its similarity to varenicline in both mechanism of action and effectiveness has not yet translated to clinical use.