NICOTINE VACCINE
SMOKING Single leading preventable cause of death. The WHO estimates: 1.3 billion smokers worldwide 5 million tobacco-related deaths
TOBACCO USE AND HEALTH Smoking harms almost all organs of the body
Respiratory diseases Heart diseases Cancer Stroke Reproductive complications.
"Quitting smoking is easy I've done it a thousand times“
-Mark Twain
WHY CESSATION ? The single most important step that smokers can take to enhance the length and quality of their lives. “
SMOKING CESSATION
“
WHAT MAKES TOBACCO SO ADDICTIVE ?
High concentration of α4β2 nACh receptors.
Mesolimbic area Pleasure, reward
Arousal, reward system
Nicotine distilled from Tobacco Carried to lungs Diffuses into brain Binds to
α4β2 nAchRs
Release of dopamine
Psychoactive effects of Nicotine
CURRENTLY AVAILABLE THERAPY FIRST – LINE AGENTS Nicotine replacement therapy 1.Transdermal patch 2.Gum 3.Nasal spray 4.Lozenge Bupropion (an atypical antidepressant) Varenicline (a partial agonist of the α4β2 nAch R)
SECOND – LINE AGENTS Nortriptyline (a tricyclic antidepressant agent). Clonidine (a central sympatholytic).
COMMON ADVERSE EFFECTS
Sleep disturbances Cough Nervousness Mouth and throat irritations
NICOTINE VACCINE
HAPTEN
NICOTINE
CARRIER PROTEIN
Advantages ▪Doesn’t act on brain ▪Longer lasting than oral agents ▪Fewer side effects
Disadvantages Repeated booster doses needed to maintain maximal antibody levels
Clinical Trials A Phase 2b study, enrolled 301 heavy smokers
Results 12-Months continuous abstinence: Nicotine vaccine 400 μg, 16% (Placebo=6% )p<0.038 12-Months continuous abstinence: Nicotine vaccine 200 μg, 14% (Placebo=6%) p<0.056
CONCLUSION The key to a successful smoking cessation program is to not only stop the urge to smoke,it must prevent relapse by preventing the initial addiction.
A nicotine vaccine may break the cycle that fuels the habit