Smoking Cessation Pharmacotherapies: Breakthroughs and Benefits

1. New Pharmacotherapies for Assisting Smokers in Their Cessation Efforts Frank Vocci, Ph.D. Director, DPMCDA December 7, 2005

2. Varenicline • Partial agonist at the 4ß2 nicotine receptor • Partial agonists have some effects like nicotine but can also act like antagonists • A dual mechanism of action is proposed: • Partial nicotine-like effects • Nicotine blockade from cigarette smoking

3. Varenicline

4. Varenicline Phase II Trials- Tonstad study

5. Rimonabant • CB1 inverse agonist/ antagonist • Stratus-US Study ( unpublished) • Quit rates in the 20 mg group were double that of placebo • Weight gain in the 20 mg group was 0.4 kg for 12 weeks versus 3.6 kg for placebo • The 20 mg group also had attenuated weight gain 1.5 kg versus and additional 3.5 kg for placebo

6. Rimonabant • May be sought after by smokers who want to quit but don’t want to gain weight • Could be tested with other therapies, especially NRT for additive effects • Has other metabolic effects which can independently reduce cardiovascular disease risk

7. Nicotine Vaccine • Being produced by three companies • Potential indications: • Aid to cessation • Prevention of relapse • And prevention of smoking

8. Nicotine Vaccine

9. Nicotine Vaccine

10. Nicotine Vaccine Blocks Nicotine Self-Administration

11. New Therapies • Offer new prospects for smokers looking for an assist to quit smoking • Each may have distinct advantages • The vaccine may be useful for relapse prevention • Other medications are also being developed