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Cytisine and the failure to market and regulate for human health
  1. Paul Aveyard1,
  2. Robert West2
  1. 1Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, University of Oxford, Oxford, UK
  2. 2Department of Epidemiology and Public Health, University College London, London, UK
  1. Correspondence to Dr Paul Aveyard, Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK; paul.aveyard{at}phc.ox.ac.uk

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Cytisine is a partial nicotinic agonist found in high concentrations of laburnum, a plant that grows easily in many parts of the world. This makes it inexpensive to manufacture. The drug has been used for many years in eastern Europe as a smoking cessation aid. The drug came to prominence in the Western world following the development of varenicline, a manufactured nicotinic partial agonist, and the publication of a systematic review of cytisine by Etter in 2006.1 Etter's review and meta-analysis included several trials published in non-English language journals, most of which were not indexed in Pubmed. The review showed evidence of effectiveness, but the trials had methodological weaknesses that detracted from the evidence. In their article published online, Hajek and colleagues2 have updated this review. What has changed?

Since the Etter review, two more studies have been added to the meta-analysis. One of these is a large trial that, had it been done by a pharmaceutical company, might be said to be a typical phase III registration trial.3 The data are now stronger that cytisine is effective. Hajek …

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Footnotes

  • Contributors The article was jointly drafted and edited by both authors.

  • Funding The work of PA and RW is supported by the UK Centre for Tobacco Control Studies, a UKCRC Public Health Research: Centre of Excellence. Funding from British Heart Foundation, Cancer Research UK, Economic and Social Research Council, Medical Research Council, and the Department of Health, under the auspices of the UK Clinical Research Collaboration, is gratefully acknowledged.

  • Competing interests PA and RW have undertaken work for the pharmaceutical industry on smoking cessation. RW's institution could stand to gain if cytisine were marketed globally because of intellectual property from the clinical trial he led.

  • Provenance and peer review Commissioned; internally peer reviewed.

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