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Trial Shows Plant-Based Drug Helps Reduce Vaping

Juul e-cigarette

Juul e-cigarette device (Mylesclark96, Wikimedia Commons)

20 Apr. 2023. First results of a clinical trial show a drug derived from plants to aid in smoking cessation helps cut the use of e-cigarettes among non-smokers of burning tobacco. Achieve Life Sciences Inc., in Vancouver, British Columbia and Seattle, released today on its web site the clinical study’s findings, which are not yet peer-reviewed.

Achieve Life Sciences is developing the drug cytisinicline to help people stop smoking, including use of electronic cigarettes, or e-cigarettes, also called vaping. E-cigarettes are battery-powered devices with a heating element that creates an aerosol vapor from a liquid containing nicotine and often a flavor. Users inhale the vapors into their lungs, but the device’s vapors can also be taken in by bystanders. National Heart, Lung, and Blood Institute, part of NIH, cites data showing long-term e-cigarette use can harm blood vessels, a type of damage not seen among cigarette smokers, increasing the risk for cardiovascular disease.

Cytisinicline is an alkaloid compound found in a number of plants with a molecular structure similar to nicotine, which also interacts with nicotinic acetylcholine receptors, or nAChRs, neurotransmitter proteins in the central nervous system. While nicotine is believed to stimulate nAChRs and increase dopamine release in the brain, cytisinicline reduces — but does not stop — dopamine production to reduce cravings. And, cytisinicline also reduces chemical binding to nicotine, thus cutting down the pleasure rewards of nicotine. The company says cytisinicline has been approved in Europe as a smoking cessation aid since the 1980s, and has been testing the drug in North America among cigarette smokers.

Abstinence from e-cigarette use

In the new clinical trial, Achieve Life Sciences is extending tests of cytisinicline to e-cigarette use. The mid-stage study enrolled 160 daily adult e-cigarette users at five sites in the U.S., randomly assigned to take a cytisinicline or placebo tablet, three times a day for 12 weeks. All trial participants, who were not smoking combustible cigarettes at the time, also received counseling on vaping cessation during the 12-week study period. A team led by Nancy Rigotti, who studies tobacco use at Mass. General Hospital and Harvard Medical School in Boston, looked primarily for the number of participants abstaining from e-cigarette use during the last four of the 12-week study period, measured by cotinine, a metabolite residue of nicotine in participants’ saliva.

Achieve Life Sciences reports about one-third (32%) of trial participants receiving cytisinicline abstained from vaping during the last four weeks of the study period, compared to 15 percent of placebo recipients, a difference large enough for statistical reliability. The company says other interim measures of vaping cessation also show benefits of cytisinicline, but does not report specific data. In addition, says Achieve Life Sciences, the lower vaping rates among cytisinicline recipients are shown across different ages, genders, and races. The company says no serious adverse effects were reported during the trial, with similar rates, 51 to 55 percent, of any adverse effects in both the cytisinicline and placebo recipient groups.

“This new study,” notes Rigotti in an Achieve Life Sciences statement, “suggests cytisinicline, which has previously helped people to quit smoking cigarettes, may also help adults to stop using e-cigarettes, another nicotine-containing product.” Cindy Jacobs, the company’s president and chief medical officer adds, “We believe that cytisinicline has the potential to become the first treatment for nicotine vaping cessation, offering new hope to those who want to quit e-cigarettes.”

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