Piyawat Dilokthornsakul

Background: Cytisine has demonstrated significant efficacy for smoking cessation, yet diverse dosing regimens have led to clinical uncertainty. To clarify whether variations in dosing duration and frequency influence therapeutic outcomes, we conducted a systematic review and network meta-analysis (NMA) evaluating the comparative efficacy and safety of different cytisine regimens against placebo.Methods: We searched PubMed, EMBASE, Scopus, MEDLINE, and the Cochrane Library through February 7, 2026. Eligible studies included randomized controlled trials (RCTs) and observational studies involving adults intending to quit. The primary outcome was continuous abstinence at 24 weeks (CAR24); secondary outcomes included CAR12, CAR48, point prevalence abstinence (PAR12, PAR24, PAR48), and adverse events. A random-effects NMA was performed. (PROSPERO: CRD420261320145).Findings: Seventeen RCTs (n=11,643) and nine observational studies (n=4,793) were analyzed. Regarding the primary outcome (CAR24), fixed-dose regimens of 3 mg three times daily for six and twelve weeks (CYT_3TID_6WK and CYT_3TID_12WK) demonstrated significant superiority over placebo, with CYT_3TID_12WK yielded the highest effect (RR 3·53, 95% CI 1·74–7·15). In contrast, the traditional 25-day titration regimen (CYT_RDT_25D) did not differ significantly from placebo (RR 1·64, 95% CI 0·90–3·00). Observational data supported these findings, showing higher odds of quitting with longer fixed-dose strategies. When compared to active controls, CYT_RDT_25D was superior to nicotine replacement therapy for self‑reported CAR24 (adjusted OR 2·54, 95% CI 1·72–3·74). Safety profiles were comparable, with sleep disturbances and gastrointestinal events reported most frequently; no severe safety concerns emerged.Interpretation: Cytisine efficacy appears regimen-dependent. Extended six- and twelve-week fixed-dose regimens offer more durable abstinence than the traditional 25-day titration. Despite variability in study quality, longer fixed-dose regimens represent promising clinical options, though further head-to-head trials are warranted to optimize dosing.

Background and Objectives: Anticholinergic burden (ACB) cumulatively leads to adverse outcomes and increased mortality. Taiwan's NHIRD prevalence studies indicate ~60% of elderly patients (≥65) annually receive anticholinergic medications. In those with polypharmacy, 60–80% were exposed to anticholinergic medications, which was linked to higher risks of pneumonia, myocardial infarction, and stroke. This study aims to survey physicians’ knowledge and attitudes on Anticholinergic Burden (ACB) in Taiwan, directly addressing a recognized gap in clinical practice. Materials and Methods: This nationwide, anonymized online 3-month survey (July–September 2025), used the KAP framework. Physicians from 92 hospitals across Taiwan were invited to participate via e-mail. The survey covered demographics, ACB knowledge, attitudes, practices, and feedback, utilizing branching logic. Data was analyzed and presented descriptively. Of 62 respondents, only 23% of physicians were aware of the term 'Anticholinergic Burden' (ACB). Knowledge of specific common medication ACB scores was low (average 1.86/10), and respondents showed significant uncertainty regarding the risks associated with high ACB. Despite 53% of physicians (33/62) rating ACB assessment as "Important/Very Important," this rarely translated into practice: most never calculated scores, and only one did so routinely. Fifty-six participants' overwhelming demand for increased ACB education emphasizes the critical need for training to close both the identified knowledge and knowledge-practice gaps. Conclusions: Physician’s knowledge of medicines with anticholinergic property is relatively low in Taiwan despite the awareness of its importance. There is a clear knowledge and knowledge-practice gap which can be addressed through targeted educational activities.

Introduction: Older patients are often exposed to medications with anticholinergic activity. Anticholinergic burden (ACB) from medicines is linked to adverse health outcomes. However, healthcare professionals’ familiarity with ACB remains poor, and there is a lack of research on knowledge, attitudes, or practices (KAPs) of ACB among Emergency department (ED) clinicians. Methods: A nationwide survey of ACB based on a pilot survey was developed using the KAP framework and assessed for face and content validity by ACB experts. It was distributed to ED physicians across the UK using REDCap through social media and professional networks. Results: Among the 108 ED physicians who responded, 54.6% (n = 59) were aware of the term ACB, but 54.2% (n = 32/59) of them were unable to describe it. Their mean scores for quantifying the ACB score and identifying side effects in older patients were 2.9 and 4.1 out of 10, respectively. 88.9% (n = 96) believed that ACB is an important consideration in older patients. 67.6% (n = 73) agreed that awareness of the consequences of prescribing anticholinergic medications to older patients is important. 50% (n = 54) emphasized the importance of being able to assess and quantify the ACB score. Of the 75 physicians who prescribed these medications, 40% (n = 30/75) were unaware of ACB. 38.7% (n = 29/75) rarely considered ACB, 30.7% (n = 23/75) never considered it, and only 1.3% (n = 1/75) always considered it. The majority of respondents (88.9%, n = 96) agreed that more education on ACB is needed in the ED. Conclusions: ED physicians in the UK have limited knowledge and awareness of ACB management and prescribing practices for older patients. However, they show positive attitudes towards their role in ACB management and a willingness to receive further education. The low response rate suggests that findings may reflect a motivated subset of clinicians. These results highlight the need for targeted education and further investigation into curricular coverage of prescribing safety and anticholinergic burden.

Introduction Older patients are often exposed to medications with anticholinergic activity. Anticholinergic burden (ACB) from medicines is linked to adverse health outcomes. However, healthcare professionals’ familiarity with ACB remains poor, and there is a lack of literature in knowledge, attitudes, or practices (KAP) of ACB among Emergency department (ED) clinicians. Methods A nationwide survey of ACB (using https://www.acbcalc.com) based on a pilot survey was developed using the KAP framework and assessed for face and content validity by ACB experts. It was distributed to ED physicians across the UK using REDCap through social media and professional networks. Results Among the 108 ED physicians who responded, 54.6% (n=59) were aware of the term ACB, but 54.2% (n=32/59) of them were unable to describe it. Their mean scores for quantifying the ACB score and identifying side effects in older patients were 2.9 and 4.1 out of 10, respectively. 88.9% (n=96) believed that ACB is an important consideration in older patients. 67.6% (n=73) agreed that awareness of the consequences of prescribing anticholinergic medications to older patients is important. 50% (n=54) emphasized the importance of being able to assess and quantify the ACB score. Of the 75 physicians who prescribed these medications, 40% (n=30/75) were unaware of ACB. 38.7% (n=29/75) rarely considered ACB, 30.7% (n=23/75) never considered it, and only 1.3% (n=1/75) always considered it. The majority of respondents (88.9%, n=96) agreed that more education on ACB is needed in the ED. Conclusion ED physicians in the UK have limited knowledge and awareness of ACB management and prescribing practices for older patients. However, they show positive attitudes towards their role in ACB management and a willingness to receive further education.

Introduction Older patients are often exposed to medications with anticholinergic activity. Anticholinergic burden (ACB) from medicines is linked to adverse health outcomes. However, healthcare professionals’ familiarity with ACB remains poor, and there is a lack of literature in knowledge, attitudes, or practices (KAP) of ACB among Emergency department (ED) clinicians. Methods A nationwide survey of ACB (using https://www.acbcalc.com) based on a pilot survey was developed using the KAP framework and assessed for face and content validity by ACB experts. It was distributed to ED physicians across the UK using REDCap through social media and professional networks. Results Among the 108 ED physicians who responded, 54.6% (n=59) were aware of the term ACB, but 54.2% (n=32/59) of them were unable to describe it. Their mean scores for quantifying the ACB score and identifying side effects in older patients were 2.9 and 4.1 out of 10, respectively. 88.9% (n=96) believed that ACB is an important consideration in older patients. 67.6% (n=73) agreed that awareness of the consequences of prescribing anticholinergic medications to older patients is important. 50% (n=54) emphasized the importance of being able to assess and quantify the ACB score. Of the 75 physicians who prescribed these medications, 40% (n=30/75) were unaware of ACB. 38.7% (n=29/75) rarely considered ACB, 30.7% (n=23/75) never considered it, and only 1.3% (n=1/75) always considered it. The majority of respondents (88.9%, n=96) agreed that more education on ACB is needed in the ED. Conclusion ED physicians in the UK have limited knowledge and awareness of ACB management and prescribing practices for older patients. However, they show positive attitudes towards their role in ACB management and a willingness to receive further education.