New medication to help quit smoking

NEW SMOKING CESSATION DRUG:

CITISINE JOINS THE NATIONAL HEALTH SERVICE

The fight against smoking is one of the major challenges facing modern medicine. In Italy, cigarette smoking is still responsible for tens of thousands of preventable deaths each year, with a significant impact on cardiovascular, oncological, and respiratory diseases.

In this context, the Italian Medicines Agency (AIFA) has recently approved reimbursement for a new smoking cessation drug based on cytisine, marking an important step in the strategy for respiratory and oncological health prevention.

What is cytisine

Cytisine is a natural alkaloid extracted from a plant in the legume family (Cytisus laburnum), used for years in several European countries to treat nicotine addiction.

The drug approved in Italy, marketed under the name Regicar, is now available as a treatment reimbursed by the National Health Service through smoking cessation centers.

Mechanism of action: “tricking” the brain

Cytisine acts on the brain’s α4β2 nicotinic receptors, the same ones activated by nicotine.

Its mechanism can be summarized in two main effects:

· reduction of cravings (the desire to smoke)

· alleviation of withdrawal symptoms

In practice, the drug “mimics” the effect of nicotine without introducing the substance responsible for addiction, allowing for gradual cessation.

Treatment protocol

Citisine therapy follows a relatively short and structured protocol:

· duration of approximately 25 days

· gradual reduction in dosage

· complete cessation of smoking within the first few days of treatment

In many cases, a second treatment cycle may be necessary, especially for smokers with high levels of dependence.

Clinical efficacy

Clinical studies have shown that cytisine is effective in promoting smoking cessation, with abstinence rates significantly higher than those of a placebo.

The treatment’s efficacy is linked not only to the medication but also to its integration with:

· medical support

· behavioral counseling

· anti-smoking center programs

For this reason, guidelines recommend an integrated approach.

A comparison with existing therapies

Before the introduction of cytisine, the main pharmacological options included:

· nicotine replacement therapy (patches, gum)

· varenicline

· bupropion

Cytisine fits into this landscape with several advantages:

· lower cost

· short treatment duration

· good tolerability profile

· easier access thanks to reimbursement

This makes it a first-line option in many clinical settings.

Impact on public health

The approval of cytisine represents an important step for several reasons:

1. Greater access to care

Reimbursement allows a greater number of patients to access treatment.

2. Reduction in the disease burden

Smoking is a major risk factor for:

· COPD

· pulmonary fibrosis

· lung cancer

· cardiovascular diseases

Interventions to help people quit smoking have a direct impact on public health.

3. Strengthening prevention

The medication complements prevention strategies, supporting educational campaigns and behavioral interventions.

Despite the benefits, it is important to emphasize that:

· cytisine is not a “miracle cure”

· it requires patient motivation

· it must be incorporated into a structured program

Success in quitting smoking depends on biological, psychological, and social factors.

The introduction of cytisine into the Italian healthcare system represents a significant step in the fight against smoking. Its value lies not only in its pharmacological efficacy but also in the possibility of expanding access to treatments whose effectiveness is based on scientific evidence (https://jamanetwork.com/journals/jama/fullarticle/2807079).

For pulmonology, this means being able to intervene more effectively on one of the main modifiable risk factors for respiratory diseases.

Cytisine represents a new therapeutic option for smoking cessation, with a particularly favorable profile of efficacy, safety, and accessibility.

In an era where medicine is increasingly focused on prevention, the introduction of concrete tools for smoking cessation represents one of the most effective interventions for improving public health.