New Zealand leads research on natural quit smoking remedy

New Zealand researchers have found that a low cost, plant-based product marketed for smoking cessation in parts of Europe for the last 40 years, is better than nicotine replacement therapy at helping smokers quit. 

Trial results show that the compound cytisine is more effective than nicotine replacement therapy (NRT) at helping smokers quit.

The trial is the first of its kind in the world and was carried out by the National Institute for Health Innovation at the University of Auckland.  The study results were published recently in the top-rated international medical journal, the New England Medical Journal.

Cytisine is a natural, plant-based compound that has been used in smoking cessation for more than 40 years in Eastern Europe and is commercially produced in Bulgaria and Poland.  The trial followed 1310 adult daily smokers who called the national Quitline in New Zealand.

 Smokers were randomly assigned to receive either cytisine for 25 days or eight weeks of NRT. Participants in both groups also received telephone-based Quitline behavioural support.

Results indicated that after using cytisine for 25 days, a smoker was more likely to have quit smoking at six months, compared to using NRT. Compared to NRT, cytisine users experienced a slight increase in side effects; the most common of which were nausea, vomiting and sleep disturbances.

 “Placebo-controlled trials showed that cytisine almost doubles the chances of still being smoke-free at six months,” says study senior author, Dr Natalie Walker, who is the Heart Foundation Douglas Senior Research Fellow (Prevention) at the University of Auckland’s National Institute for Health Innovation. “We wanted to see how effective cytisine was compared to NRT at helping smokers quit.”

 In New Zealand and many other Western countries NRT is the most common medication used to support people to quit smoking.

 Cytisine is an alkaloid which naturally occurs in the Golden Rain (Laburnum anagyroides) and other members of the Fabaceae plant family.

“To the brain cytisine looks a little like nicotine and so it works to alleviate any urges to smoke and reduces the severity of nicotine withdrawal symptoms.  Plus, if you do smoke whilst using cytisine it will be less satisfying - making quitting easier”, says Dr Walker.

Cytisine is a similar type of drug to varenicline (the most effective smoking cessation treatment available, marketed by Pfizer), but is substantially cheaper (cytisine: US$20-$30 for 25-days, NRT: US$112-$685 for 8-10 weeks, varenicline: US$474-501 for 12 weeks).

“There is a big opportunity for low and middle income countries to access a low priced quit remedy,” says Dr Walker. “It’s great for countries that cannot afford more expensive smoking cessation medicines.”

Cytisine is licensed for use as an ‘over the counter’ medication, on prescription or via the internet in a number of Central and Eastern European countries, but it is not yet available in New Zealand.  

“Internationally, very few researchers are undertaking research on the use of cytisine for smoking cessation,” says Associate Professor Chris Bullen, Director of the National Institute for Health Innovation.

“Researchers at the University of Auckland are leading the way.  For example, other researchers in the Department of Pharmacology and at the School of Pharmacy are looking at how cytisine is absorbed and metabolised by the body,” he says.

The trial is funded by the Health Research Council of New Zealand and is one of a number of studies the Institute have undertaken to find innovative options for smokers to stop smoking to achieve smoke-free New Zealand by 2025.  The last trial they completed was one involving e-cigarettes

The study, ‘Randomized comparison of cytisine versus nicotine for smoking cessation’, by Dr Natalie Walker (National Institute for Health Innovation, University of Auckland), Dr Colin Howe (NIHI), Dr Marewa Glover (Centre for Tobacco Control Research, UoA), Dr Hayden McRobbie (Queen Mary University London), Associate Professor Jo Barnes (School of Pharmacy, UoA), Dr Vili Nosa (UoA), Ms Varsha Parag (NIHI), Mr Bruce Bassett (Quit Group), Associate Professor Chris Bullen (Director, NIHI).

Source: Auckland University

‘Smart’ drugs won’t make smart people smarter, research concludes

Dr. Ahmed Dahir Mohamed is in the School of Psychology at The University of Nottingham Malaysia Campus. Credit: The University of Nottingham

The study carried out by Dr Ahmed Dahir Mohamed, in the School of Psychology at The University of Nottingham Malaysia Campus, and published in the open access journal PLOS ONE, showed the drug had negative effects in healthy people.

Dr Mohamed said: "We looked at how the drug acted when you are required to respond accurately and in a timely manner. Our findings were completely opposite to the results we expected."

In a randomised double blind study, 'Modafinil increases the latency of response in the Hayling Sentence Completion Test in Healthy Volunteers: A Randomised Controlled Trial', they administered 32 participants with the drug and 32 with a placebo. All the participants were given a famous neuropsychological task known as the Hayling Sentence Completion Test in which they were asked to respond both quickly and accurately. Dr Mohamed found the drug slowed down reaction times, impaired their ability to respond in a timely manner and failed to improve their performance of the task.

Dr Mohamed said: "It has been argued that Modafinil might improve your performance by delaying your ability to respond. It has been suggested this 'delay dependent improvement' might improve cognitive performance by making people less impulsive. We found no evidence to support those claims.

"Our research showed that when a task required instant reactions the drug just increased reaction times with no improvement to cognitive performance."

This backs up the findings of a previous study carried out by Dr Mohamed and published in September 2014 in The Journal of Creative Behaviour. The study: The Effects of Modafinil on Convergent and Divergent Thinking of Creativity: A Randomised Controlled Trial showed that the so called 'smart' drug impaired the participant's ability to respond in a creative way particularly when they were asked to respond laterally -- outside the box.

Does Modafinil benefit anyone?

When Dr Mohamed looked at participant's ability to problem solve in a creative manner he found that those who weren't particularly creative to start with were improved by the drug while those who were creative were impaired by the drug. He said: "Our study backs up previous research that suggests psychostimulants improve people at the lower end of the spectrum in cognition whereas they impair people who are at the optimum level of cognitive function -- healthy people for example. It looks like Modafinil is not helpful for healthy individuals and it might even impair their ability to respond and might stifle their lateral thinking, while people who have some sort of deficiency in creativity are helped by the drug."

What can make us smarter?

Ahmed Mohamed's research was carried out while he was at Cambridge University. He has since moved to The University of Nottingham Malaysia Campus where he will be looking at the effects of non-pharmacological interventions, such as meditation, exercise and diet on the healthy brain. He is also currently using Electroencephalography (EEG) to study how mindfulness can affect the healthy adolescent brain.

Dr Mohamed said: "What I have found in my doctoral studies is that if you are already a healthy person and functioning at an optimum level, it is really difficult to improve your cognition. But the brain of the adolescent is still in development and you might be able to improve cognition at this stage of our development through positive interaction, healthy diet or mindfulness."

Source: University of Nottingham