Abstract
Background. Partial agonists of α4b2 nicotinic acetylcholine receptors are the most effective treatment strategy for tobacco smoking cessation. They are able to alleviate withdrawal symptoms and to reduce smoking satisfaction.
 The aim of this study was to review the efficacy and safety of nicotinic receptor partial agonists varenicline and cytisine, for smoking cessation.
 Methods. A search for randomized controlled trials was done using the terms (“cytisine”, “tabex”, “varenicline” or 'partial agonists of nicotinic receptors’) in MEDLINE, EMBASE, eLibrary in May 2018. Types of participants, the doses and duration of the treatments, efficacy and safety parameters, quality of randomization and blinding procedures were evaluated. Bayesian network meta-analysis was performed.
 Results. Cytisine overcame placebo in the 12, 24 and 52 weeks of therapy with the following odds ratios (ORs) for abstinence: 3.3 (95% CrI 1.8–5.8), 3.9 (2.4–6.7), 3.8 (CrI 1.3–11,9) accordingly. Varenicline in 2 mg/day dose overcame placebo in the 12, 24 and 52 weeks of therapy with the ORs: 4.0 (3.3–4.7), 3.1 (2.5–3.7), 2.9 (2.2–4.1) accor dingly. Varenicline in 1 mg/day dose overcame placebo in 12 and 52 weeks of therapy, the ORs were 3.0 (2.0–4.7) and 2.3 (1.3–4.4) accordingly. Varenicline in 0.5 mg/day dose overcame placebo in 12 weeks of therapy only with the OR 2.4 (1.3–4.4). Cytisine and varenicline 2 mg/day were associated with more gastrointestinal disturbances than placebo with the ORs 6.2 (2.1–22.8) and 2.4 (2.0–2.8) accordingly. Cytisine and varenicline 2 mg/day were associated with more psychiatric problems than placebo with ORs 5.2 (1.9–15.1) and 1.6 (1.3–1.9) accordingly. There was no difference in serious adverse events between the investigated drugs and placebo: OR for cytisine was 2.4 (0.8–6.8), varenicline 0.5 mg/day – 2.0 (0.5–6.6), varenicline 1.0 mg/day – 1.0 (0.3–2.7), varenicline 2 mg/day – 1.0 (0.7–1.4).
 Conclusion. Cytisine was proved to be as effective and safe aid for smoking cessation as varenicline.
Highlights
Partial agonists of α4b2 nicotinic acetylcholine receptors are the most effective treatment strategy for tobacco smoking cessation
Cytisine and varenicline 2 mg/day were associated with more gastrointestinal disturbances than placebo with the odds ratios (ORs) 6.2 (2.1–22.8) and 2.4 (2.0–2.8)
Cytisine and varenicline 2 mg/day were associated with more psychiatric problems than placebo with ORs 5.2 (1.9–15.1) and 1.6 (1.3–1.9)
Summary
Для цитирования: Радченко Е.В., Суховская О.А., Галанкин Т.Л., и др. Сетевой метаанализ: сравнение эффективности и безопасности частичных агонистов никотиновых ацетилхолиновых рецепторов варениклина и цитизина для лечения никотиновой зависимости. Варениклин в дозе 2 мг/сут также значимо превосходил эффекты плацебо на 12, 24 и 52-й неделе терапии. Варениклин в дозе 1 мг/сут значимо превосходил эффекты плацебо на 12-й и 52-й неделе терапии, ОШ составило соответственно 3,0 (2,0–4,7) и 2.3 (1,3–4,4). Варениклин в дозе 0,5 мг/сут значимо превосходил эффекты плацебо на 12-й неделе терапии, ОШ составило 2,4 (1,2–4,8). Цитизин и варениклин имели более высокий риск развития нежелательных побочных явлений со стороны желудочно-кишечного тракта по сравнению с плацебо: ОШ для цитизина составило 6,2 (2,1–22,8), варениклина — 2 мг/сут 2,4 (2,0–2,8).
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