尼古丁结合疫苗——一种新的戒烟方法
2011/11/21
摘要
尽管过去的45年中，吸烟的人数显著下降，但烟草相关的疾病仍然是导致美国人口死亡的主要原因。虽然烟草使用的健康风险已经得到了很清楚的阐述，传统尼古丁依赖仍然是很难对付的一大挑战。用于控制烟草使用和烟草依赖的一线治疗措施已经多达七项，然而每年的戒烟率仍然相当低，这表明有必要通过进一步研究开发出新的更有效的戒烟方法。为了改善长期的戒断率，降低尼古丁对大脑的强化作用，有研究者开发出尼古丁疫苗作为尼古丁依赖治疗的新方法。尼古丁疫苗治疗能使机体产生尼古丁特异性抗体，从而结合外源性尼古丁，形成分子量较大的复合物，该复合物不能穿过血脑屏障，进而限制了大脑对尼古丁吸收的速度和量。临床试验显示，受试者接种尼古丁疫苗治疗后12个月时，与体内尼古丁特异性抗体水平较低的受试者相比，产生高水平尼古丁特异性抗体的受试者戒烟成功率更高。与尼古丁疫苗相关的副作用较轻，主要是局部反应，全身不良作用轻微。最常见的副作用包括注射部位触痛和疼痛、全身不适、头痛和肌肉痛。虽然尼古丁疫苗的临床应用还有待临床III期试验的证实，但作为一种新的给药模式，能改善患者的治疗依从性，提高戒断率。
尽管过去的45年中，吸烟的人数显著下降，但烟草相关的疾病仍然是导致美国人口死亡的主要原因。虽然烟草使用的健康风险已经得到了很清楚的阐述，传统尼古丁依赖仍然是很难对付的一大挑战。用于控制烟草使用和烟草依赖的一线治疗措施已经多达七项，然而每年的戒烟率仍然相当低，这表明有必要通过进一步研究开发出新的更有效的戒烟方法。为了改善长期的戒断率，降低尼古丁对大脑的强化作用，有研究者开发出尼古丁疫苗作为尼古丁依赖治疗的新方法。尼古丁疫苗治疗能使机体产生尼古丁特异性抗体，从而结合外源性尼古丁，形成分子量较大的复合物，该复合物不能穿过血脑屏障，进而限制了大脑对尼古丁吸收的速度和量。临床试验显示，受试者接种尼古丁疫苗治疗后12个月时，与体内尼古丁特异性抗体水平较低的受试者相比，产生高水平尼古丁特异性抗体的受试者戒烟成功率更高。与尼古丁疫苗相关的副作用较轻，主要是局部反应，全身不良作用轻微。最常见的副作用包括注射部位触痛和疼痛、全身不适、头痛和肌肉痛。虽然尼古丁疫苗的临床应用还有待临床III期试验的证实，但作为一种新的给药模式，能改善患者的治疗依从性，提高戒断率。
（刘国梁 审校）
Pharmacotherapy. 2011 Jul;31(7):703-13.
Pharmacotherapy. 2011 Jul;31(7):703-13.
Ottney AR.
Source
1 Department of Pharmacy Practice, North Dakota State University, Fargo, North Dakota.
Abstract
Despite significant reductions over the past 45 years in the percentage of individuals smoking cigarettes, tobacco-related illnesses remain the leading cause of preventable death in the United States. Although the health risks of tobacco use have been clearly outlined, addiction to nicotine traditionally has been one of the more challenging habits to break. Seven first-line therapies to treat tobacco use and dependence are available; however, annual quit rates remain surprisingly low, suggesting that continued research and development in the area of smoking cessation are warranted. In an attempt to improve long-term quit rates and blunt the reinforcing effects of nicotine in the brain, the nicotine conjugate vaccine was developed as a novel approach for the treatment of nicotine dependence. Vaccine administration produces nicotine-specific antibodies that bind to nicotine from exogenous sources, creating a large unit that is not able to cross the blood-brain barrier, which limits the rate and extent of nicotine absorption into the brain. Results of clinical trials indicate that individuals achieving high nicotine-specific antibody levels with the nicotine conjugate vaccine have greater success with smoking cessation at 12 months compared with those with lower levels. Adverse effects associated with the nicotine conjugate vaccine have been primarily mild and localized in nature, with minimal systemic effects. The most commonly reported adverse effects include tenderness and ache at the injection site, general discomfort, headache, and muscle ache. Awaiting results of phase III trials, the true clinical utility of the nicotine conjugate vaccine is yet to be realized, although this investigational vaccine represents a distinctive administration model that may improve patient adherence and increase the ability to achieve abstinence from cigarette smoking.
Source
1 Department of Pharmacy Practice, North Dakota State University, Fargo, North Dakota.
Abstract
Despite significant reductions over the past 45 years in the percentage of individuals smoking cigarettes, tobacco-related illnesses remain the leading cause of preventable death in the United States. Although the health risks of tobacco use have been clearly outlined, addiction to nicotine traditionally has been one of the more challenging habits to break. Seven first-line therapies to treat tobacco use and dependence are available; however, annual quit rates remain surprisingly low, suggesting that continued research and development in the area of smoking cessation are warranted. In an attempt to improve long-term quit rates and blunt the reinforcing effects of nicotine in the brain, the nicotine conjugate vaccine was developed as a novel approach for the treatment of nicotine dependence. Vaccine administration produces nicotine-specific antibodies that bind to nicotine from exogenous sources, creating a large unit that is not able to cross the blood-brain barrier, which limits the rate and extent of nicotine absorption into the brain. Results of clinical trials indicate that individuals achieving high nicotine-specific antibody levels with the nicotine conjugate vaccine have greater success with smoking cessation at 12 months compared with those with lower levels. Adverse effects associated with the nicotine conjugate vaccine have been primarily mild and localized in nature, with minimal systemic effects. The most commonly reported adverse effects include tenderness and ache at the injection site, general discomfort, headache, and muscle ache. Awaiting results of phase III trials, the true clinical utility of the nicotine conjugate vaccine is yet to be realized, although this investigational vaccine represents a distinctive administration model that may improve patient adherence and increase the ability to achieve abstinence from cigarette smoking.
Pharmacotherapy. 2011 Jul;31(7):703-13.
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