- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04286295
Cytisine Compared to Combination NRT in Relapsed Smokers (CYTvsNRT+)
Pilot RCT of Cytisine Compared to Combination Nicotine Replacement Therapy to Reduce Cigarette Consumption in Relapsed Smokers
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Cigarette smoking is a causative factor in the development of coronary heart disease (CHD), and is the most dangerous form of tobacco use. Effective treatments for smoking cessation exist but relapse to cigarette smoking is common, principally due to nicotine addiction and related symptoms of withdrawal. Little is known about how best to support smokers who have relapsed in subsequent attempts to change their smoking behavior. One emerging treatment has features that might make it appealing to smokers and may be effective in the setting of recent relapse: cytisine.
Cytisine is a plant-based smoking cessation medication with more than 50 years of use in central/eastern Europe. Cytisine is a partial agonist of nicotinic acetylcholine receptors (nAChRs), which is central to the effect of nicotine on the reward pathway. Cytisine acts by reducing the rewarding effect of nicotine and attenuating nicotine withdrawal symptoms. A recent review concluded that cytisine is the most promising future smoking cessation treatment. Cytisine is inexpensive to produce and is currently priced much lower than other cessation medications. It is well-tolerated by smokers and requires a shorter treatment period (i.e. 25 days) than conventional treatments. Because it is plant-based, cytisine may be attractive for smokers who prefer 'natural' medicines. Numerous placebo-controlled studies have demonstrated the safety and efficacy of cytisine. One high-quality pragmatic non-inferiority trial (n = 1310) found that cytisine was superior to nicotine replacement therapy (NRT) in improving self-reported continuous abstinence rates at 1 week, and 1, 2 and 6 months when both groups received minimal behavioural support. In Canada, cytisine is marketed as the natural health product Cravv™.
The long-term goal is to conduct a definitive, large-scale randomized controlled trial (RCT) of the efficacy of cytisine compared to conventional treatment (i.e. combination NRT) for smoking cessation among smokers who have relapsed to smoking following hospitalization for a CHD-related event. Prior to conducting a larger, definitive RCT there is a need to conduct a pilot study to better understand the potential feasibility of such a trial.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Evyanne Wooding
- Phone Number: 17596 613-696-7000
- Email: ewooding@ottawaheart.ca
Study Locations
-
-
Ontario
-
Ottawa, Ontario, Canada, K1Y 4W7
- University of Ottawa Heart Insitute - Prevention and Wellness Centre
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
- Child
- Adult
- Older Adult
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Patient is enrolled in UOHI's Quit Smoking Program;
- Patient has relapsed to daily smoking ≥10 cigarettes per day within 90 days of discharge from UOHI;
- Patient is currently smoking ≥10 cigarettes per day.
Exclusion Criteria:
- Patient has used NRT, cytisine, varenicline, bupropion or a nicotine-containing vaping device within in the past 15 days;
- Patient is unavailable to come to UOHI for assessments;
- Patient is unable to provide informed consent;
- Patient is unable to comprehend the intervention instructions (in the opinion of qualified investigators)
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Cytisine
Cravv™ (Zpharm, Waterloo) is a natural health product licensed by Health Canada to assist with smoking cessation; each oral capsule contains 1.5mg of cytisine.
The dosing is as follows: 6 capsules daily for the first 3 days; 5 capsules daily for days 4-12; 4 capsules daily for days 13-16; 3 capsules daily for days 17-20; and 1-2 capsules daily for days 21-25.
|
Cytisine is a plant-based smoking cessation medication.
Cytisine acts by reducing the rewarding effect of nicotine and attenuating nicotine withdrawal symptoms.
A recent review concluded that cytisine is the most promising future smoking cessation treatment.
Cytisine is inexpensive to produce and is currently priced much lower than other cessation medications.
It is well-tolerated by smokers and requires a shorter treatment period than conventional treatments.
Because it is plant-based, cytisine may be attractive for smokers who prefer 'natural' medicines.
Numerous placebo-controlled studies have demonstrated the safety and efficacy of cytisine.
One high-quality pragmatic non-inferiority trial (n = 1310) found that cytisine was superior to nicotine replacement therapy (NRT) in improving self-reported continuous abstinence rates at 1 week, and 1, 2 and 6 months when both groups received minimal behavioural support.
|
Active Comparator: NRT+
The Nicoderm® patch plus Nicorette® Lozenge will be provided to participants in the combination NRT group.
Participants smoking less than 15 cigarettes per day will be provided with 14 mg patches while those smoking 15 or more cigarettes per day will receive 21 mg patches.
Participants will be told to apply a new patch each morning.
Participants will be instructed to use the lozenges as needed (up to 15 per day) to overcome nicotine cravings.
Lozenges are available in both 2mg and 4mg strengths.
For those who are smoking less than 15 cigarettes per day, they will be given the 2mg strength.
For those who are smoking 15 or more cigarettes per day, they will receive the 4mg strength.
|
The Nicoderm® patch plus Nicorette® Lozenge will be provided to participants in the combination NRT group.
Participants will be instructed to apply a new patch each day.
They will continue to wear patches for 25 days.
Other Names:
Participants in the NRT group will receive Nicorette Lozenges to use during their 25-day quit attempt.
They will receive enough lozenges to last for the 25-day treatment period.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Feasibility of study
Time Frame: Baseline to 25-day follow-up
|
will be feasible to recruit 10 relapsed smokers with CHD per month to a study of cytisine vs. combination NRT
|
Baseline to 25-day follow-up
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Treatment completion
Time Frame: Baseline to 25-day follow-up
|
Participants will complete at least 70% of their prescribed treatment
|
Baseline to 25-day follow-up
|
Attrition
Time Frame: Baseline to 25-day follow-up
|
There will be less than 5% attrition over a 25-d treatment period
|
Baseline to 25-day follow-up
|
Cigarette consumption
Time Frame: Baseline to 25-day follow-up
|
Cigarette consumption will drop by 5 cigs/d more in the cytisine group compared to the combination NRT group by the end of the 25-d treatment period
|
Baseline to 25-day follow-up
|
Arterial Stiffness
Time Frame: Baseline to 25-day follow-up
|
Arterial stiffness, as measured by pulse wave velocity, will improve in smokers who are able to achieve complete abstinence (i.e.
smoking zero cigarettes per day).
|
Baseline to 25-day follow-up
|
Collaborators and Investigators
Investigators
- Principal Investigator: Andrew Pipe, MD, Ottawa Heart Institute Research Corporation
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
- Myocardial Ischemia
- Heart Diseases
- Cardiovascular Diseases
- Vascular Diseases
- Arteriosclerosis
- Arterial Occlusive Diseases
- Coronary Disease
- Coronary Artery Disease
- Physiological Effects of Drugs
- Neurotransmitter Agents
- Molecular Mechanisms of Pharmacological Action
- Autonomic Agents
- Peripheral Nervous System Agents
- Cholinergic Agents
- Ganglionic Stimulants
- Nicotinic Agonists
- Cholinergic Agonists
- Nicotine
Other Study ID Numbers
- 20190720-01H
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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