Approval Probability
TA Base Rate
Adjusted LOA
ML Risk
Also known as Tabex, cytisinicline
cytisine · 12 trials · 5 indications
Assess whether subjects randomized to Arm B (3 mg cytisinicline TID for 12 weeks plus behavioral support) have a higher probability of nicotine vaping cessation from Week 9 to Week 12 post-randomization as compared to subjects randomized to Arm A (placebo TID for 12 weeks plus behavioral support). Successful vaping cessation is defined as weekly vaping abstinence during the last 4 weeks of the 12-week treatment period (Week 9 through Week 12) using quantitative cotinine levels at \<10 ng/mL for biochemical verification and subject's self-report of no vaping using a daily electronic diary
Smoking abstinence as verified by weekly expired carbon monoxide (CO) measurements ≤ 10 parts per million (ppm).
Smoking abstinence as verified by weekly expired CO measurements ≤ 10 ppm.
Vaping abstinence verified weekly using quantitative saliva cotinine levels at \< 10 ng/mL for biochemical verification and participants' self-report of no vaping.
The daily cigarette counts (number of cigarettes smoked in the past 24 hours) were self-reported by participants in the diary. Percentage of expected cigarettes smoked was computed for each participant at the end of treatment (cigarette score), based on daily cigarette counts during treatment vs the screening period. The percentage of expected cigarettes smoked was computed as Y = (100 x N) / (T x R) where N represents total number of cigarettes smoked each day over the treatment period from Day 1 to Day 25; T represents number of post-randomization days where number of cigarettes smoked is recorded; and R represents the average number of cigarettes smoked daily over the 7-day screening period as baseline. T\*R represents the total number of cigarettes that would have been smoked without intervention over the number of recorded days. Separate statistical analyses were performed for the two cytisine administration schedules (commercial and TID).
The daily cigarette counts (number of cigarettes smoked in the past 24 hours) were self-reported by participants in the diary. Percentage of expected cigarettes smoked was computed for each participant at the end of treatment (cigarette score), based on daily cigarette counts during treatment vs the screening period. (See Outcome Measure 1 description for details.) The sensitivity analysis of the primary outcome measure was only performed if results of "Statistical Analysis 5" for Outcome Measure 1 demonstrated the placebo treatment arms (commercial and TID) were not significantly different, and so could be pooled. Separate statistical analyses were performed for the two cytisine administration schedules (commercial and TID).
The daily cigarette counts (number of cigarettes smoked in the past 24 hours) were self-reported by participants in the diary. Percentage of expected cigarettes smoked was computed for each participant at the end of treatment (cigarette score), based on daily cigarette counts during treatment vs the screening period. (See Outcome Measure 1 description for details.) The sensitivity analysis of the primary outcome measure was only performed if results of "Statistical Analysis 5" for Outcome Measure 1 demonstrated the placebo treatment arms (commercial and TID) were not significantly different, and so could be pooled. Separate statistical analyses were performed for the two cytisine administration schedules (commercial and TID).
τ=5 h for Dose 1 and Dose 2 and τ=24 h for Dose 3
τ=5 h for Dose 1 and Dose 2 and τ=24 h for Dose 3
Accumulation of cytisinicline following TID administration will be assessed by estimating R(Cmax), where R is the ratio of the pharmacokinetic parameter following administration of Dose 1 on Day 8 vs. single-dose administration under fasting conditions during Period 1 or 2.
Accumulation of cytisinicline following TID administration will be assessed by estimating R(AUC0-τ), where R is the ratio of the pharmacokinetic parameter following administration of Dose 1 on Day 8 vs. single-dose administration under fasting conditions during Period 1 or 2.
Time invariance will be assessed as R(AUC0-τ/AUC0-∞), where AUC0-τ is estimated on Day 8 Dose 1 and AUC0-∞ is estimated for the single-dose under fasting conditions during Period 1 or 2.
Time to steady state will be assessed by visual inspection of the Ctrough versus time plot.
An adverse event (AE) is defined as any untoward medical occurrence that does not necessarily have to have a causal relationship with the treatment. A serious AE is any untoward medical occurrence or effect, that, at any dose: results in death; is life-threatening; requires hospitalization or prolongation of existing hospitalization; results in persistent or significant disability or incapacity; results in a congenital abnormality or birth defect; or is an important medical event which requires medical intervention to prevent one of the above. Treatment emergent events are those that occurred after the first dose of study drug.
| Arm | Type | Description |
|---|---|---|
| Arm A | PLACEBO_COMPARATOR | 12 weeks of placebo + behavioral support; 400 subjects |
| Arm B | ACTIVE_COMPARATOR | 12 weeks cytisinicline + behavioral support; 400 subjects |
| Cytisinicline 3 mg TID | EXPERIMENTAL | Cytisinicline 3 mg TID for 52 weeks. |
| Placebo + Behavioral Support | PLACEBO_COMPARATOR | One placebo tablet orally (PO) three times daily (TID) for 12 weeks plus behavioral support |
| 6-Week Cytisinicline + 6-Week Placebo + Behavioral Support | EXPERIMENTAL | One cytisinicline tablet PO TID for 6 weeks followed by one placebo tablet PO TID for 6 weeks plus behavioral support |
| 12-Week Cytisinicline + Behavioral Support | EXPERIMENTAL | One cytisinicline tablet PO TID for 12 weeks plus behavioral support |
| Cytisinicline + Placebo + Behavioral Support | EXPERIMENTAL | one cytisinicline tablet PO TID plus behavioral support for 6 weeks followed by one placebo tablet PO TID plus behavioral support for 6 weeks |
| Cytisinicline + Behavioral Support | EXPERIMENTAL | one cytisinicline tablet PO TID plus behavioral support for 12 weeks |
| 1.5 mg Cytisine, Commercial Schedule | EXPERIMENTAL | 1.5 mg cytisine dose using the commercial 25-day titration schedule + behavioral support |
| 3.0 mg Cytisine, Commercial Schedule | EXPERIMENTAL | 3.0 mg cytisine dose using the commercial 25-day titration schedule + behavioral support |
| Placebo, Commercial Schedule | PLACEBO_COMPARATOR | Placebo tablets using the commercial 25-day titration schedule + behavioral support |
| 1.5 mg Cytisine, TID Schedule | EXPERIMENTAL | 1.5 mg cytisine dose for 25 days using a simplified 3 times daily (TID) schedule + behavioral support |
| 3.0 mg Cytisine, TID Schedule | EXPERIMENTAL | 3.0 mg cytisine dose for 25 days using a simplified TID schedule + behavioral support |
| Placebo, TID Schedule | PLACEBO_COMPARATOR | Placebo tablets for 25 days using a simplified TID schedule + behavioral support |
| Part 1: Cytisinicline 3 mg Once Daily (QD), Fasting | EXPERIMENTAL | 3 mg cytisinicline tablet administered in the morning, between 7:00 and 9:00 AM, in fasting conditions on Day 1 (Period 1) or Day 3 (Period 2). Participants will fast overnight for at least 10 hours before cytisinicline administration and will continue to fast for 4 hours after dosing. |
| Part 1: Cytisinicline 3 mg QD, Fed | EXPERIMENTAL | 3 mg cytisinicline tablet administered in the morning, between 7:00 and 9:00 AM, in fed conditions on Day 1 (Period 1) or Day 3 (Period 2). After an overnight fasting of at least 10 hours, participants will consume a standard high-fat-high-calorie meal within 30 minutes. Cytisinicline will be administered with 240 mL of water within 5 minutes after completion of the meal. |
| Part 2: Cytisinicline 3 mg 3 Times Daily (TID) | EXPERIMENTAL | 3 mg cytisinicline tablet administered TID each day on Day 5 to 8 (Period 3) as follows: Dose 1 will be administered in the morning between 7:00 and 9:00 AM,; Dose 2 at 5 hours (±10 minutes) after Dose 1; Dose 3 at 5 hours (±10 minutes) after Dose 2. Cytisinicline will be administered on an empty stomach (cytisinicline given at least 2 hours before food or 1 hour after food). |
| Group 1: Normal Renal Function | EXPERIMENTAL | Participants with normal renal function receive a 3 mg single dose of cytisinicline. |
| Group 2: Mild Renal Impairment | EXPERIMENTAL | Participants with mild renal impairment receive a 3 mg single dose of cytisinicline. |
| Group 3: Moderate Renal Impairment | EXPERIMENTAL | Participants with moderate renal impairment receive a 3 mg single dose of cytisinicline. |
| Group 4: Severe Renal Impairment | EXPERIMENTAL | Participants with severe renal impairment receive a 3 mg single dose of cytisinicline. |
| Group 5: ESRD Participants Undergoing Dialysis | EXPERIMENTAL | Participants with ESRD undergoing dialysis receive a 3 mg single dose of cytisinicline on 2 occasions: after and prior to a dialysis session. |
| Sequence 1 | EXPERIMENTAL | Participants will receive the assigned study drug after an overnight fast on Day 1 during each of 4 periods in the following order: * Cytisinicline, 6 mg (therapeutic dose) (2 cytisinicline tablets+6 placebo tablets) * Cytisinicline, 24 mg (supratherapeutic dose) (8 cytisinicline tablets) * Placebo (negative control) (8 placebo tablets) * Moxifloxacin 400 mg PO (positive control) (1 tablet) There will be a minimum 5 day washout between dosing periods. |
| Sequence 2 | EXPERIMENTAL | Participants will receive the assigned study drug after an overnight fast on Day 1 during each of 4 periods in the following order: * Cytisinicline, 24 mg (supratherapeutic dose) (8 cytisinicline tablets) * Moxifloxacin 400 mg PO (positive control) (1 tablet) * Cytisinicline, 6 mg (therapeutic dose) (2 cytisinicline tablets+6 placebo tablets) * Placebo (negative control) (8 placebo tablets) There will be a minimum 5 day washout between dosing periods. |
| Sequence 3 | EXPERIMENTAL | Participants will receive the assigned study drug after an overnight fast on Day 1 during each of 4 periods in the following order: * Placebo (negative control) (8 placebo tablets) * Cytisinicline, 6 mg (therapeutic dose) (2 cytisinicline tablets+6 placebo tablets) * Moxifloxacin 400 mg PO (positive control) (1 tablet) * Cytisinicline, 24 mg (supratherapeutic dose) (8 cytisinicline tablets) There will be a minimum 5 day washout between dosing periods. |
| Sequence 4 | EXPERIMENTAL | Participants will receive the assigned study drug after an overnight fast on Day 1 during each of 4 periods in the following order: * Moxifloxacin 400 mg PO (positive control) (1 tablet) * Placebo (negative control) (8 placebo tablets) * Cytisinicline, 24 mg (supratherapeutic dose) (8 cytisinicline tablets) * Cytisinicline, 6 mg (therapeutic dose) (2 cytisinicline tablets+6 placebo tablets) There will be a minimum 5 day washout between dosing periods. |
| Sequence 5 | EXPERIMENTAL | Participants will receive the assigned study drug after an overnight fast on Day 1 during each of 4 periods in the following order: * Cytisinicline, 24 mg (supratherapeutic dose) (8 cytisinicline tablets) * Placebo (negative control) (8 placebo tablets) * Cytisinicline, 6 mg (therapeutic dose) (2 cytisinicline tablets+6 placebo tablets) * Moxifloxacin 400 mg PO (positive control) (1 tablet) There will be a minimum 5 day washout between dosing periods. |
| Sequence 6 | EXPERIMENTAL | Participants will receive the assigned study drug after an overnight fast on Day 1 during each of 4 periods in the following order: * Placebo (negative control) (8 placebo tablets) * Moxifloxacin 400 mg PO (positive control) (1 tablet) * Cytisinicline, 24 mg (supratherapeutic dose) (8 cytisinicline tablets) * Cytisinicline, 6 mg (therapeutic dose) (2 cytisinicline tablets+6 placebo tablets) There will be a minimum 5 day washout between dosing periods. |
| Sequence 7 | EXPERIMENTAL | Participants will receive the assigned study drug after an overnight fast on Day 1 during each of 4 periods in the following order: * Cytisinicline, 6 mg (therapeutic dose) (2 cytisinicline tablets+6 placebo tablets) * Cytisinicline, 24 mg (supratherapeutic dose) (8 cytisinicline tablets) * Moxifloxacin 400 mg PO (positive control) (1 tablet) * Placebo (negative control) (8 placebo tablets) There will be a minimum 5 day washout between dosing periods. |
| Sequence 8 | EXPERIMENTAL | Participants will receive the assigned study drug after an overnight fast on Day 1 during each of 4 periods in the following order: * Moxifloxacin 400 mg PO (positive control) (1 tablet) * Cytisinicline, 6 mg (therapeutic dose) (2 cytisinicline tablets+6 placebo tablets) * Placebo (negative control) (8 placebo tablets) * Cytisinicline, 24 mg (supratherapeutic dose) (8 cytisinicline tablets) There will be a minimum 5 day washout between dosing periods. |
| Cohort 1: Cytisine 6.0 mg | EXPERIMENTAL | Cytisine will be administered in the morning, orally, with 240 mL of water, after fasting overnight for at least 10 hours. |
| Cohort 1: Placebo | PLACEBO_COMPARATOR | Placebo will be administered in the morning, orally, with 240 mL of water, after fasting overnight for at least 10 hours. |
| Cohort 2: Cytisine 9.0 mg | EXPERIMENTAL | Cytisine will be administered in the morning, orally, with 240 mL of water, after fasting overnight for at least 10 hours. |
| Cohort 2: Placebo | PLACEBO_COMPARATOR | Placebo will be administered in the morning, orally, with 240 mL of water, after fasting overnight for at least 10 hours. |
| Cohort 3: Cytisine 12.0 mg | EXPERIMENTAL | Cytisine will be administered in the morning, orally, with 240 mL of water, after fasting overnight for at least 10 hours. |
| Cohort 3: Placebo | PLACEBO_COMPARATOR | Placebo will be administered in the morning, orally, with 240 mL of water, after fasting overnight for at least 10 hours. |
| Cohort 4: Cytisine 15.0 mg | EXPERIMENTAL | Cytisine will be administered in the morning, orally, with 240 mL of water, after fasting overnight for at least 10 hours. |
| Cohort 4: Placebo | PLACEBO_COMPARATOR | Placebo will be administered in the morning, orally, with 240 mL of water, after fasting overnight for at least 10 hours. |
| Cohort 5: Cytisine 18.0 mg | EXPERIMENTAL | Cytisine will be administered in the morning, orally, with 240 mL of water, after fasting overnight for at least 10 hours. |
| Cohort 5: Placebo | PLACEBO_COMPARATOR | Placebo will be administered in the morning, orally, with 240 mL of water, after fasting overnight for at least 10 hours. |
| Cohort 6: Cytisine 21.0 mg | EXPERIMENTAL | Cytisine will be administered in the morning, orally, with 240 mL of water, after fasting overnight for at least 10 hours. |
| Cohort 6: Placebo | PLACEBO_COMPARATOR | Placebo will be administered in the morning, orally, with 240 mL of water, after fasting overnight for at least 10 hours. |
| Cohort 7: Cytisine 24.0 mg | EXPERIMENTAL | Cytisine will be administered in the morning, orally, with 240 mL of water, after fasting overnight for at least 10 hours. |
| Cohort 7: Placebo | PLACEBO_COMPARATOR | Placebo will be administered in the morning, orally, with 240 mL of water, after fasting overnight for at least 10 hours. |
| Cohort 8: Cytisine 27.0 mg | EXPERIMENTAL | Cytisine will be administered in the morning, orally, with 240 mL of water, after fasting overnight for at least 10 hours. |
| Cohort 8: Placebo | PLACEBO_COMPARATOR | Placebo will be administered in the morning, orally, with 240 mL of water, after fasting overnight for at least 10 hours. |
| Cohort 9: Cytisine 30.0 mg | EXPERIMENTAL | Cytisine will be administered in the morning, orally, with 240 mL of water, after fasting overnight for at least 10 hours. |
| Cohort 9: Placebo | PLACEBO_COMPARATOR | Placebo will be administered in the morning, orally, with 240 mL of water, after fasting overnight for at least 10 hours. |
| Schedule A: Fed Then Fasted | EXPERIMENTAL | Schedule A (6 participants): * Period 1: cytisine (2 x 1.5 mg tablets) will be administered 30 minutes after the start of a high fat breakfast (fed state) * Period 2: cytisine (2 x 1.5 mg tablets) will be administered after an overnight fast of at least 10 hours (fasting state) |
| Schedule B: Fasted Then Fed | EXPERIMENTAL | Schedule B (6 participants): * Period 1: cytisine (2 x 1.5 mg tablets) will be administered after an overnight fast of at least 10 hours (fasting state) * Period 2: cytisine (2 x 1.5 mg tablets) will be administered 30 minutes after the start of a high fat breakfast (fed state) |
| Name | Type | Description |
|---|---|---|
| Cytisinicline | DRUG | Tablet, 3 times a day (TID), 12 weeks |
| Placebo | DRUG | Tablet, 3 times a day (TID), 12 weeks |
| Behavioral Support | BEHAVIORAL | 16 behavioral support sessions, starting prior to randomization and through Week 12, 3 additional sessions during the follow-up period. |
| Cytisine | DRUG | film coated tablet containing 1.5 mg cytisine in a single tablet |
| Placebo Comparator | DRUG | 1.5 mg cellulose powder to match final weight of the cytisine tablet |
| Moxifloxacin | DRUG | 400 mg tablets |
Inclusion Criteria: * Male or female subjects, age ≥18 years. * Test positive for cotinine using a point-of-care Oral Fluid Screening Device (OFD) with positive detection at ≥30 ng/mL cotinine. * Current daily nicotine-containing electronic cigarette usage as recorded in a screening diary for at le...
Cytisine is an investigational small molecule being developed for smoking cessation. It is currently in Phase 2 clinical development and has not been approved by the FDA. The drug is being studied in adult smokers to evaluate its effectiveness as a smoking cessation aid.
Cytisine is a small molecule that acts as a nicotinic acetylcholine receptor partial agonist. It binds to the same receptors in the brain that nicotine targets, which may help reduce cravings and withdrawal symptoms associated with smoking cessation.
Cytisine is being developed by Achieve Life Sciences, Inc., a biopharmaceutical company traded on the NASDAQ under the ticker symbol ACHV. The company is conducting clinical trials to evaluate the drug's safety and efficacy for smoking cessation.
Cytisine is currently in Phase 2 clinical development for smoking cessation. It has completed four clinical trials, including Phase 1 and Phase 2 studies, but it remains investigational and has not received FDA approval. The drug is still being evaluated in clinical studies.
Cytisine has completed four clinical trials, including NCT03268343, NCT03509948, NCT03709823, and NCT03848208. These studies evaluated the drug's bioavailability, safety, and efficacy in adult smokers across the United Kingdom, United States, and Portugal.
Cytisine is a distinct investigational compound being developed by Achieve Life Sciences. It is not the same as FDA-approved smoking cessation drugs like varenicline or bupropion. Cytisine is a plant-derived alkaloid that acts as a nicotinic receptor partial agonist, similar in mechanism to varenicline.