Nancy Rigotti, MD: How Cytisinicline Works to Help Adults Quit Vaping

Following her discussion with the HCPLive editorial team about her team’s findings from the ORCA-V1 trial, Nancy Rigotti, MD, was asked several other questions about her team’s results regarding cytisinicline’s potential as a treatment for cessation of nicotine e-cigarettes (vaping).¹

The product itself is an alkaloid which is plant-based and formulated to lower adults’ nicotine dependence through the targeting of nicotinic acetylcholine receptors.² Rigotti was asked to explain in more detail how cytisinicline works as a potential therapy to help adults quit vaping nicotine, as well as what sets it apart from other cessation aids.

“Cytisinicline works as a partial agonist for nicotine receptors in the brain that mediate nicotine dependence…it's a partial agonist, meaning it gives you some of the effect of it waking up the receptors as if nicotine were there,” Rigotti said. “So it keeps you from getting nicotine withdrawal symptoms when you stop nicotine. It's also an antagonist, which means that if you have the medicine on board, that it's blocking the receptors. If you vape, you will not get the effect of vaping from taking in the nicotine that you would have had.”

Rigotti noted that the product is highly similar to varenicline (Chantix), which she highlights is the most successful single product for tobacco smoking cessation. The distinction is that this product may be utilized for vaping cessation.

Later, Rigotti was asked about the significance of cytisinicline’s nature as a plant-based product.

“I think it is reassuring to many people that this is a natural product,” she explained. “I forget the Latin name but it goes by the name of ‘golden rain,’ it's a flowering tree that grows in eastern and central Europe and probably many other places. So I think that the advantage of this is that it could be cheap to make, because you just have to grow the trees.”

Lastly, Rigotti was asked how she envisioned the results of this trial impacting clinical practice and public health strategies for addressing nicotine addiction.

“Unfortunately, the medicine’s not on the market and it's not something that people can start using, at least not in the United States,” Rigotti said. “And the dose that we use here is a higher and better dose than has been used in eastern and central Europe. What we plan to do is put together a larger trial that would last for a longer period of time after stopping the medicine to really test the hypothesis that this will work. If so, then I believe that the company, which I'm not directly affiliated with, would be probably thinking about getting FDA approval for vaping cessation indication.”

Rigotti highlighted the lack of current US Food and Drug Administration (FDA)-approved medicines for vaping cessation.

To learn more about the topic discussed here, view the full interview posted above.

The quotes used in this summary were edited for the purposes of clarity. Rigotti provided consultation to and received a research grant from Achieve Life Sciences.

References

1. ^{Smith T. New Findings on Cytisinicline Treatment for Quitting E-Cigarettes, with Nancy Rigotti, MD. HCPLive. May 11, 2024. https://www.hcplive.com/view/new-findings-on-cytisinicline-treatment-for-quitting-e-cigarettes-with-nancy-rigotti-md. Date accessed: May 12, 2024.}
2. ^{Rigotti NA, Benowitz NL, Prochaska JJ, et al. Cytisinicline for Vaping Cessation in Adults Using Nicotine E-Cigarettes: The ORCA-V1 Randomized Clinical Trial. JAMA Intern Med. Published online May 06, 2024. doi:10.1001/jamainternmed.2024.1313.}