Cytisine Therapy Improved Smoking Cessation in the Randomized Screening and Multiple Intervention on Lung Epidemics Lung Cancer Screening Trial

• Published in: Journal of thoracic oncology Vol. 17; no. 11; pp. 1276 - 1286
• Main Authors: Pastorino, Ugo, Ladisa, Vito, Trussardo, Sara, Sabia, Federica, Rolli, Luigi, Valsecchi, Camilla, Ledda, Roberta E., Milanese, Gianluca, Suatoni, Paola, Boeri, Mattia, Sozzi, Gabriella, Marchianò, Alfonso, Munarini, Elena, Boffi, Roberto, Gallus, Silvano, Apolone, Giovanni
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2022
• Subjects: Clinical trial; Cytisine; Early Detection of Cancer; Humans; Lung cancer screening; Lung Neoplasms - diagnosis; Lung Neoplasms - prevention & control; Nicotine - adverse effects; Nicotine - therapeutic use; Quinolizidine Alkaloids - adverse effects; Quinolizidine Alkaloids - therapeutic use; Smoking Cessation; Tobacco; Cytisine; Smoking cessation; Clinical trial; Tobacco; Lung cancer screening
• ISSN: 1556-0864; 1556-1380
• DOI: 10.1016/j.jtho.2022.07.007

Cytisine, a partial agonist-binding nicotine acetylcholine receptor, is a promising cessation intervention. We conducted a single-center, randomized, controlled trial (RCT) in Italy to assess the efficacy and tolerability of cytisine as a smoking cessation therapy among lung cancer screening participants. From July 2019 to March 2020, the Screening and Multiple Intervention on Lung Epidemics RCT enrolled 869 current heavy tobacco users in a low-dose computed tomography screening program, with a randomized comparison of pharmacologic intervention with cytisine plus counseling (N = 470) versus counseling alone (N = 399). The primary outcome was continuous smoking abstinence at 12 months, biochemically verified through carbon monoxide measurement. At the 12-month follow-up, the quit rate was 32.1% (151 participants) in the intervention arm and 7.3% (29 participants) in the control arm. The adjusted OR of continuous abstinence was 7.2 (95% confidence interval: 4.6–11.2). Self-reported adverse events occurred more frequently in the intervention arm (399 events among 196 participants) than in the control arm (230 events among 133 participants, p < 0.01). The most common adverse events were gastrointestinal symptoms, comprising abdominal swelling, gastritis, and constipation. The efficacy and safety observed in the Screening and Multiple Intervention on Lung Epidemics RCT indicate that cytisine, a very low-cost medication, is a useful treatment option for smoking cessation and a feasible strategy to improve low-dose computed tomography screening outcomes with a potential benefit for all-cause mortality.