Quitting smoking in 2024, a new compound to quit smoking and an antidiabetic to avoid the extra pounds

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With the start of the new year, one of the most tried resolutions is to quit smoking. But sometimes you don't find the key that helps you quit the habit and the fear of replacing it with another makes you give up on the effort.

Well, the latest publication in the scientific journal Addiction has found that cytisine, a generic, low-cost smoking cessation aid that has been used in Eastern Europe since the 1960s, increases the chances of successfully quitting smoking more than twice as much compared to placebo and may be more effective than nicotine replacement therapy.

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Bless you.

Health Ministry wants to "take out of the drawer" the comprehensive anti-smoking plan

• Written by: MANUEL F. BUSTELO Madrid

Health Ministry wants to "take out of the drawer" the comprehensive anti-smoking plan

Bless you.

Recigarum, the new drug to quit smoking in 25 days financed by the Ministry of Health

• Written by: NAIARA BROCAL Madrid

Recigarum, the new drug to quit smoking in 25 days financed by the Ministry of Health

On the other hand, a way has been discovered to avoid the fear of gaining weight when quitting tobacco. The diabetes drug dulaglutide (marketed as Trulicity) may significantly reduce a woman's risk of substantial weight gain after quitting smoking, according to a secondary analysis of clinical trial data published in BMJ Nutrition Prevention & Health.

How does an antidiabetic dodge the pounds of quitting?

For many, gaining weight is a fear when quitting. The study, published in BMJ Nutrition Prevention & Health, shows that this population group is five times more likely than men to gain a lot of weight after quitting smoking.

Women appear to have higher rates of relapse into smoking than men. One possible explanation is that they may be more concerned about the risk of significant weight gain after quitting smoking. This is a suggestion because, in reality, there is no solid evidence for this, the researchers note.

Results from a previously published clinical trial showed that, compared to a dummy treatment, the diabetes drug dulaglutide significantly reduced weight gain in those who had quit smoking. But, "it is not clear whether this weight loss is gender-specific," say researchers from the Department of Endocrinology, Diabetology and Metabolism at the University Hospital Basel and the Department of Clinical Research at the University of Basel, both in Switzerland.

To corroborate the observations, they reanalyzed data from this trial to see if there were gender differences in weight loss or gain in the 12 weeks after quitting smoking.

The trial included 255 adults, 155 of whom were women. The average age ranged from 42 to 44 years and the number of cigarettes smoked daily was 20 on average over a period of 19 to 22 years.

Trial participants were randomly assigned to receive weekly injections of 1.5 mg/0.5 mL of dulaglutide or 0.5 mL of dummy treatment, in addition to the smoking cessation drug varenicline 2 mg/day and behavioral counseling over a 12-week period.

GLP-1 HORMONE MIMIC

Dulaglutide mimics the effects of the hormone GLP-1 that is naturally produced in the gut in response to food, helping to regulate the amount of glucose in the blood and weight gain.

At the start of the test, the average weight was just over 72 kilos among women (a BMI of 26) and just over 92.5 kilos among men (a BMI of 29).

After 12 weeks, dulaglutide had reduced the risk of weight gain in both sexes compared to the sham treatment.

Women taking dulaglutide lost 1 to 2 kilograms, compared with a weight gain of 2 to 2.5 kilograms for women in the dummy treatment group. The men who took dulaglutide lost just over a pound compared to weight gain of about 2 pounds among those in the dummy treatment group.

Although weight change, in general, did not differ between the sexes, women were more likely to gain a lot of weight. Dulaglutide was associated with a significantly lower risk of substantial weight gain, defined as an increase of more than 6% among women.

Substantial weight gain was nearly five times more common in women than men in the dummy treatment group: 24% versus 5%.

Similarly, substantial weight gain in women taking dulaglutide was significantly less common than among those taking the dummy treatment: 1% (1 in 83) versus 24% (17 in 72). No such effects were observed among men: 0% (0/44) vs. 5% (3/56).

Surprisingly, the positive effects of dulaglutide on weight, the researchers said had no impact on short-term dropout rates in either men or women, which were relatively high in both: 98 (63 percent) in women and 65 (65 percent) in men.

The study also shows that the risk of gaining weight after quitting smoking can change over time or depend on other factors, such as the degree of nicotine dependence or age.

"The data suggest that an adjunctive treatment with dulaglutide could be particularly useful for patients who face a high risk of substantial weight gain after quitting smoking, such as women." In addition, another target group could be people of both sexes who failed in several attempts to quit smoking due to weight gain."

New compound to quit: cytisine

Addiction's work notes that cytisine has a benign safety profile, with no evidence of serious safety concerns. Sounds perfect for your New Year's resolution, doesn't it? But there's a problem: cytisine is not licensed or marketed in most countries outside of Central and Eastern Europe, making it unavailable in most parts of the world, including many low- and middle-income countries where it could make a big difference to global health.

Cytisine is a plant-based compound that relieves smoking withdrawal symptoms. It was first synthesized in Bulgaria in 1964 as Tabex and subsequently spread to other countries in Eastern Europe and Asia, where it is still marketed. In 2017, Polish pharmaceutical company Aflofarm began selling it as Desmoxan, a prescription-only drug, and Canada approved it as an over-the-counter natural health product, Cravv.

Since cytisine is a low-cost drug, it could be part of a plan to increase accessibility to drug therapy for smokers, which tends to be limited in low- and middle-income countries (LAMIs).

The lead author of the study, Omar De Santi, explains that his study adds to the evidence that cytisine is an effective and inexpensive aid to quit smoking. "It could be very useful in reducing smoking in LAMI countries where cost-effective smoking cessation drugs are urgently needed. Worldwide, smoking is considered the leading cause of preventable death. Cytisine has the potential to be one of the big answers to that problem."

This study brought together the results of eight randomized controlled trials comparing cytisine with a placebo, involving nearly 6,000 patients. The combined results showed that cytisine increases the chances of successfully quitting smoking by more than twice as much compared to placebo.

The paper also looked at two randomised controlled trials comparing cytisine with nicotine replacement therapy, with modest results in favour of cytisine, and three trials comparing cytisine with varenicline, with no clear benefit for cytisine.

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