geoffrey modest medical blogs

  The NY Times had a recent article on cytisine as an effective treatment for smoking cessation:  https://www.nytimes.com/2024/10/02/well/quit-smoking-cytisine.html?smid=nytcore-ios-share&referringSource=articleShare&sgrp=c-cb   they make a few well-substantiated points: -- it is pretty easy to stop smoking, the issue is maintaing abstinence (and 47%  of those who try to quit are smoking 1 year later:  https://pmc.ncbi.nlm.nih.gov/articles/PMC3723776/  ) -- cytisine was developed as a pill in Bulgaria in 1964 and has been used in Eastern Europe for 50 years for smoking cessation -- cytisine was approved in Canada in 2017 and Britain last year for smoking cessation -- there have been many scientific articles showing a great effect of cytisine in smoking cessation (several noted below), with a 2014 editorial by Nancy Rigotti referring to cytisine as “a tobacco treatment hiding in plain sight”:  https://www.nejm.org/doi/full/10.1056/NEJMe1412313 ...

The American thoracic Society just published guidelines for medications to help with smoking cessation, strongly supporting the primary use of varenicline (see   smoking cessation ATS guidelines2020  in dropbox, DOI: 10.1164/rccm.202005-1982ST, or  https://www.atsjournals.org/doi/pdf/10.1164/rccm.202005-1982ST  )   Recommendations: medications for tobacco-dependent adults   1. varenicline is recommended over nicotine patch (strong recommendation, moderate certainty in the estimated effects)      -- 14 RCTs: varenicline had a 20% increased likelihood of seven-day abstinence at 6 months follow-up, RR 1.20 (1.09-1.32), absolute risk reduction 40 more per 1000 patients; also more effective during the treatment period Itself      -- varenicline also had a slightly lower risk of serious adverse effects vs nicotine patch, 3 fewer per 1000 patients      -- though the cost of varenicline is about 8 tim...

there were a few important articles in the jan 8th JAMA on smoking -- i will highlight 2 of them on varenicline, a partial agonist which binds with high affinity as well as specificity to neuronal acetylcholine receptors. smoking cessation in smokers is the most significant single intervention to decrease mortality, and 62% of deaths in female smokers/60% of deaths in male smokers are attributable to smoking. 1. i had sent out a general smoking cessation article about one year ago from JAMA which referenced some small study finding benefit of combining varenicline with bupropion. the current study (see smoking varenicline and buprop jama 2014 in the dropbox, or doi:10.1001/jama.2013.283185) was a 12-month multi-center RCT comparing varenicline with bupropion vs varenicline with placebo, with both medications dosed as is generally recommended.  results:     --500 patients (mean age 42, 94% white, 45% women, 78% completed at least some college -- study done at Mayo cli...