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
Drug
12 Week
Quit Rate %
52 Week
placebo 18 10
Bupropion 30 16
Varenicline 44 22

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Stratus-US Study ( unpublished)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