Dr. Frank Bures: Does Europe have a smoking-cessation secret?

"Cytisine has been available in the former socialist economy countries of eastern Europe since 1964. Made by the Bulgarian drug company Sopharma AD and sold as Tabex, it has never been available to most of the rest of the world. A new study from New Zealand reported in the Dec. 18 New England Journal of Medicine compared the cessation results of cytisine to varenicline." http://www.winonadailynews.com Tobacco is likely the most addictive chemical we humans encounter (except maybe for Oreo cookies. Yes, someone studied them and found an addictive result). The search continues for aids to help people quit tobacco use. Nicotine gum, lozenges, patches, (all called nicotine replacement therapy), some drugs first intended for psychiatric disease treatments, counseling, hypnosis, etc. have all been tried. Currently the favorite in the United States is a drug called varenicline — brand-name Chantix. Varenicline was derived from a drug called cytisine. The plant Cytisus laborinium (Golden Rain acacia) first was used as a smoking substitute during World War II. This led to it being used as a smoking-cessation aid, with the extraction of the chemical cytosine coming later. The drug company Pfizer created different forms of it, called analogs, leading to varenicline’s formulation and its fast-track approval by the Federal Drug Administration and introduction in 2006 to the United States. Cytisine and varenicline both bind to the cell receptors for nicotine, of which there are many. The one they have the most affinity for is nicotinic acetylcholine receptor apha4beta2, the cell receptor that appears to mediate nicotine dependence. They only bind partially to give less kick than nicotine itself, but still decrease cravings. Cytisine has been available in the former socialist economy countries of eastern Europe since 1964. Made by the Bulgarian drug company Sopharma AD and sold as Tabex, it has never been available to most of the rest of the world. A new study from New Zealand reported in the Dec. 18 New England Journal of Medicine compared the cessation results of cytisine to varenicline. It pointed out right away that the cost of cytisine was far less than all others. The authors listed 25 days of cytisine cost $20 to $30, nicotine replacement therapy for 8 to 10 weeks cost $112 to $685 and varenicline cost $474 to $501 for 12 weeks. This was the first study to compare the two drugs directly. The subjects were culled from New Zealand’s national smoking quit line. They collected 1,310 people, divided them between the drugs, and used a phone self-reporting system for results and side effects. Any time this format is used, criticisms abound. But the results were still valuable. The reported percentages of abstinence for cytisine vs. varenicline were 60 percent vs. 46 percent at one week, 40 percent vs. 31 percent at one month, 31 percent vs. 22 percent at two months, and 22 percent vs. 15 percent at six months. Past studies of cytisine are few. One in 2011 from Poland and England compared it to placebo. At 12 months, 8.4 percent of the cytisine group were abstinent vs. 2.4 percent in the placebo crowd. Here, both groups took pills for 25 days without knowing which was which, so-called double blinded. Adverse reactions were mostly nausea, vomiting and sleep disorders for both drugs. In other reports, varenicline has engendered occasional suicidal thoughts and behaviors, while cytisine has not. Interestingly, plants that contain cytisine, including common broom and mescalbean, have been used as recreational drugs. However, too much cytisine can cause convulsions, heart pain, headache, respiratory failure and death. Oops. No reference was made about the derivation of the dosing schedule of Tabex. The doctor who wrote an editorial pointed out that tobacco is now the leading cause of preventable death worldwide, and China now uses and manufactures the most tobacco of any country. Both the article and editorial agree that cytisine is at least as good as varenicline — and considerably cheaper. Of course, more studies are needed for approval in the Unite States. That is the stumbling block here and in Western Europe. The stumbling block to many people wanting to quit now is the cost of what’s available. Cytisine would make it affordable almost everywhere. Perhaps some highly motivated politico can become the standard bearer for getting it approved on a fast track, especially with 50 years' experience other countries. And maybe not. As Milton Berle, the comedian, said, “You can a lead man to Congress, but you can’t make him think.”