A Review of Smoking Cessation Interventions

Ashish Maseeh, MD, and Gagandeep Kwatra, MD

Disclosures
In This Article

Nicotine Vaccine

A novel approach to assist in smoking cessation is the development of a nicotine-specific vaccine that attenuates the rewarding effects of cigarette smoke and, thus, precludes the reason to smoke. Attaching nicotine to a suitable antigenic protein stimulates formation of antibodies (Nic-IgG) that have a high affinity and specificity for nicotine.[71,72,73] These antibodies sequester nicotine in blood, thereby preventing its entry into the brain.[72,74] The vaccine also blocks the nicotine-induced release of dopamine in the nucleus accumbens,[75] thus not only blocking the rewarding effects of nicotine, but also preventing nicotine from relieving the symptoms of withdrawal. This, it is hoped, would significantly reduce the rates of relapse.

Efficacy: Human studies are yet to elucidate the safety and efficacy of such a vaccine. However, animal studies so far have been encouraging and have demonstrated the efficacy of both active and passive immunization.[73,76,77] Rats immunized with this vaccine were significantly less sensitive to behavioral effects of high concentrations of nicotine relative to their nonimmunized counterparts.[76]

Dosage: Although human trials are yet to generate conclusive information regarding the safety, efficacy, and dosage of the vaccine, it could be administered on 2 to 4 occasions with effects lasting for several months.[74]

Advantages: The absence of daily dosing would make the vaccine not only convenient, but would also ensure compliance. By significantly curtailing the rewarding and pleasantly familiar effects of nicotine, it may permit focus on the other aspect of cigarette smoking, namely, behavioral. If found to be safe, these could be used in tandem with other pharmacotherapies (eg, bupropion to maximize the therapeutic benefits and decrease the rates of relapse.[74] These antibodies do not cross-react with cotinine (a major metabolite of nicotine) or acetylcholine and, thus, specifically alter the pharmacokinetic and pharmacodynamic properties of nicotine.[71,74,76] Finally, the vaccine does not inherently have central adverse effects, because it does not cross the blood-brain barrier.

Adverse Effects & Disadvantages: Increasing the dose of nicotine by increased smoking is a simple way to circumvent the effects of the vaccine.[74] In addition, the limited period of protection offered by the vaccine means that either booster injections need to be administered or a depot formulation developed to provide protection for an extended duration.

Some other potential challenges that need to be addressed include restricting the cost of vaccine, and its inclusion in immunization programs routinely that may raise the issue of freedom of choice, even if a wrong one.

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