Inexpensive drug, automated phone system effective in helping patients quit

Two potentially low-cost smoking cessation treatments were evaluated in studies published last week.

In the first study, New Zealand researchers conducted a pragmatic, open-label trial in 1,310 adult smokers who called the national quitline. They were randomized to receive either 8 weeks of nicotine-replacement therapy (NRT) or 25 days of cytisine, a partial agonist that binds the nicotinic acetylcholine receptor, similar to varenicline. All patients received telephone support. Cytisine was provided free in the mail, and NRT was provided through low-cost vouchers. Results were published in the Dec. 18 New England Journal of Medicine.

At 1 month, 40% of the cytisine group reported continuous abstinence, compared to 31% of the NRT group. Greater abstinence was also reported with cytisine at 1 week, 2 months, and 6 months, leading researchers to conclude that it was superior to NRT. Self-reported adverse events (mostly nausea, vomiting, and sleep disorders) were higher in the cytisine group (288 events in 204 patients vs. 174 events in 134 patients). Study authors noted that because many patients had tried NRT before, they may have been more accustomed to its side effects and thus may have been less likely to report them. The study was limited by the open-label design and the difference in access to the treatments (mailed vs. vouchers), among other factors.

Although it is not currently available in most of the world, cytisine has been sold in Eastern Europe as an inexpensive smoking cessation aid for 50 years, according to an accompanying editorial. The effects seen with the drug in this trial are similar to those shown with varenicline in other trials. Further study and efforts to bring cytisine to market are important because the drug is substantially cheaper than current pharmacotherapies for smoking cessation, the editorial concluded.

In the second study, Boston researchers identified adult smokers of low socioeconomic status through their primary care clinics' electronic health records (EHRs). The 707 patients were contacted by interactive voice response and, if they consented, randomized to either usual care or an intervention of telephone-based motivational counseling, free NRT for 6 weeks, and referrals to community services. Results were published by JAMA Internal Medicine on Dec. 15.

At 9 months, 17.8% of patients in the intervention group reported abstinence for the past 7 days, compared to 8.1% of those in usual care (odds ratio, 2.5; 95% CI, 1.5 to 4.0; number needed to treat, 10). In the intervention group, patients who participated in telephone counseling were more likely to quit than those who didn't (21.2% vs. 10.4%; P<0.001), as were those who used a community referral (43.6% vs. 15.3%; P<0.001). Resources for physical activity, educational opportunities, and job counseling were the most commonly requested referrals. The study authors concluded that such an intervention, making use of EHRs and interactive voice response, could effectively promote tobacco cessation in disadvantaged populations and potentially reduce disparities.

A limitation of the study is that most eligible patients were never even reached by the phone system, and an additional significant percentage declined to participate, an accompanying commentary noted. However, the trial does “challenge assumptions that low-income smokers are not interested in quitting and that treatment is not effective in this population,” which is important because these patients make up an increasing proportion of U.S. smokers, the commentary said.