The n e w e ng l a n d j o u r na l of m e dic i n e 2. Jaiswal S, Fontanillas P, Flannick J, et al. Age-related clonal 4. Shlush LI, Zandi S, Mitchell A, et al. Identification of pre- hematopoiesis associated with adverse outcomes. N Engl J Med 2014;371:2488-98. 3. Lawrence MS, Stojanov P, Mermel CH, et al. Discovery and saturation analysis of cancer genes across 21 tumour types. Nature 2014;505:495-501. leukaemic haematopoietic stem cells in acute leukaemia. Nature 2014;506:328-33. DOI: 10.1056/NEJMc1500684 Cytisine versus Nicotine for Smoking Cessation To the Editor: Walker et al. (Dec. 18 issue)1 describe the use of cytisine, as compared with nicotine, for smoking cessation. Although cytisine is perceived as a novelty in the West, it has been used in daily medical practice in Poland for more than 50 years.2 In 1976, the first English-language study on the use of cytisine in Poland was published, based on the observations of 1968 patients.3 Cytisine is currently undergoing a renaissance in Poland. Two Polish studies — a cohort study conducted in 2003 through 20054 and a randomized, controlled trial conducted in 2006 through 20105 — showed the safety and effec- 600,000 tiveness of the drug. In 2012, a Polish generic drug company broke the monopoly by introducing a new cytisine product, Desmoxan. Cytisine is very inexpensive in Poland, costing under $20 for full treatment. Its consumption has grown by factor of 10 since 2000 (Fig. 1). In 2013 alone, after cytisine became available over the counter and was heavily advertised, sales of the drug doubled. The use of cytisine is widespread, and it is considered to be safe by medical professionals and consumers. It seems that the use of cytisine is a major factor behind the decline in smoking in Poland — in the past 2 years, 500,000 smokers have quit.6 It is certainly desirable for this success to be replicated elsewhere. Witold Zatoński, M.D., Sc.D. Maria Sklodowska-Curie Memorial Cancer Center Warsaw, Poland wazatonski@gmail.com 500,000 No. of Units Purchased Mateusz Zatoński, M.A., M.Sc. London School of Hygiene and Tropical Medicine London, United Kingdom. 400,000 No potential conflict of interest relevant to this letter was reported. 300,000 1. Walker N, Howe C, Glover M, et al. Cytisine versus nicotine for smoking cessation. N Engl J Med 2014;371:2353-62. 2. Tutka P, Zatoński W. Cytisine for the treatment of nicotine 200,000 100,000 20 0 20 0 0 20 1 0 20 2 0 20 3 0 20 4 0 20 5 0 20 6 0 20 7 0 20 8 0 20 9 1 20 0 1 20 1 1 20 2 13 0 Figure 1. Total Units of Cytisine Purchased as SmokingCessation Therapy in Poland, 2000–2013. Each unit (or package) of cytisine is one full treatment for smoking cessation. The solid black line indicates the trend in sales between 2000 and 2013. addiction: from a molecule to therapeutic efficacy. Pharmacol Rep 2006;58:777-98. 3. Granatowicz J. Smoking cessation through the use of cytisine and other chemotherapy. World Smoking Health 1976;1:811. 4. Zatoński W, Cedzynska M, Tutka P, West R. An uncontrolled trial of cytisine (Tabex) for smoking cessation. Tob Control 2006;15:481-4. 5. West R, Zatoński W, Cedzynska M, et al. Placebo-controlled trial of cytisine for smoking cessation. N Engl J Med 2011;365:1193-200. 6. Zatonski W, Sulkowska U, Przewozniak K, Zatonski M. Malignant cancer epidemiology in Poland. In: Potrykowska A, Strzelecki Z, Szymborski J, Witkowski J, eds. Cancer incidence and mortality versus the demographic situation in Poland. Warsaw, Poland: Governmental Population Council, 2014:30-49. (In Polish.) DOI: 10.1056/NEJMc1500342 1072 n engl j med 372;11 nejm.org march 12, 2015 The New England Journal of Medicine Downloaded from nejm.org on March 15, 2015. For personal use only. No other uses without permission. Copyright © 2015 Massachusetts Medical Society. All rights reserved.