Which novel therapies have been used for the treatment of nicotine addiction?

Updated: Jul 16, 2018
  • Author: R Gregory Lande, DO, FACN; Chief Editor: Glen L Xiong, MD  more...
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In view of the rather limited success achieved with most pharmacologic and behavioral therapies is rather limited, there is clearly a need for other and better treatments. One novel approach is to immunize smokers against nicotine. The rationale is that antibodies induced by the vaccine should bind nicotine in the blood, thereby preventing it from reaching the nicotine receptors in the brain and breaking the cycle of nicotine addiction.

A prototype vaccine against nicotine was developed and studied in a randomized trial in which 229 subjects received 5 intramuscular injections of the nicotine vaccine and 112 placebo; the vaccine was safe and generally well tolerated, despite failure to increase continuous abstinence rates significantly, and results were significant in subgroup analyses. [51] Although more studies are needed, immunotherapy appears to have opened a new avenue to the treatment of nicotine addiction.

In a preliminary assessment of the first phase III trial, the nicotine vaccine NicVAX (Nabi Biopharmaceuticals, Rockville, MD) failed to meet the primary endpoint of abstinence from smoking at 12 months. [52] Results showed that subjects treated with NicVAX quit smoking at roughly the same rate (about 11%) as subjects who received placebo. A second phase III trial is under way.

Mecamylamine is a nicotine antagonist that—at least in principle—would seem capable of playing a role in smoking cessation. Much as opiate antagonists prevent opiate users from achieving a high, mecamylamine would prevent smokers from deriving any pleasurable affects from nicotine. The combination of mecamylamine with the nicotine patch increased successful quit rates. Routine clinical use of mecamylamine must await further research. [53]

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