Cytisinicline—a plant-based chemical—can help people stop using e-cigarettes when paired with behavioral support, a study in JAMA Internal Medicine reports. Compared with individuals who received placebo along with behavioral support, those who received cytisinicline had twice the rate of vaping abstinence after 12 weeks.
“While these findings warrant confirmation in a phase 3 trial with a larger sample size and longer follow-up, they are consistent with the demonstrated efficacy of cytisinicline for cigarette smoking cessation,” wrote Nancy Rigotti, M.D., of Harvard Medical School and colleagues. “For individuals seeking to quit vaping, cytisinicline might fill the existing gap in pharmacologic treatments and enhance the emerging evidence of efficacy of behavioral treatments for vaping cessation.”
Rigotti and colleagues enrolled 160 adults who used e-cigarettes but not regular cigarettes and wanted to quit vaping. Of these participants, 107 took 3 mg of cytisinicline three times daily for 12 weeks while the other 53 took identical placebo pills. All participants received 10 minutes of vaping-cessation support each week from trained counselors. At these weekly visits, the participants also reported their e-cigarette use over the prior week and provided a saliva sample to measure cotinine, a nicotine metabolite.
After 12 weeks, 31.8% of the participants who took cytisinicline achieved continuous vaping abstinence (defined as four weeks without vaping, confirmed with cotinine measurements), compared with 15.1% of those who took placebo. The researchers found no evidence that variables like age, sex, race, degree of e-cigarette dependence, or preferred e-liquid flavor affected the participants’ ability to abstain.
Four participants left the study because of adverse events; the most common side effects reported were abnormal dreams, insomnia, anxiety, headache, and fatigue. Cytisinicline did not appear to contribute to cigarette smoking. Rates of regular cigarette smoking were similar in the cytisinicline and placebo groups at the end of the study.
“While the present trial is an important step toward developing effective e-cigarette treatments, there is much more to be done,” wrote Suchitra Krishnan-Sarin, Ph.D., and Lisa Fucito, Ph.D., of Yale School of Medicine in an accompanying editorial. “E-cigarette technology is constantly evolving to include novel nicotine forms, flavorants, and device configurations to deliver nicotine palatably, rapidly, and at high levels, which likely exceeds delivery of nicotine from cigarettes. The efficacy of medications like cytisinicline for people with greater addiction from the use of these novel e-cigarettes may be diminished.”
For related information, see the Psychiatric News special report, “Vaping—A Call to Action for Psychiatrists.”
(Image: Getty Images/iStock/Bulat Silvia)
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