A vaccine against nicotine for smoking cessation: a randomized controlled trial

Abstract

Background: Tobacco dependence is the leading cause of preventable death and disabilities worldwide and nicotine is the main substance responsible for the addiction to tobacco. A vaccine against nicotine was tested in a 6-month randomized, double blind phase II smoking cessation study in 341 smokers with a subsequent 6-month follow-up period.

Methodology/principal findings: 229 subjects were randomized to receive five intramuscular injections of the nicotine vaccine and 112 to receive placebo at monthly intervals. All subjects received individual behavioral smoking cessation counseling. The vaccine was safe, generally well tolerated and highly immunogenic, inducing a 100% antibody responder rate after the first injection. Point prevalence of abstinence at month 2 showed a statistically significant difference between subjects treated with Nicotine-Qbeta (47.2%) and placebo (35.1%) (P = 0.036), but continuous abstinence between months 2 and 6 was not significantly different. However, in subgroup analysis of the per-protocol population, the third of subjects with highest antibody levels showed higher continuous abstinence from month 2 until month 6 (56.6%) than placebo treated participants (31.3%) (OR 2.9; P = 0.004) while medium and low antibody levels did not increase abstinence rates. After 12 month, the difference in continuous abstinence rate between subjects on placebo and those with high antibody response was maintained (difference 20.2%, P = 0.012).

Conclusions: Whereas Nicotine-Qbeta did not significantly increase continuous abstinence rates in the intention-to-treat population, subgroup analyses of the per-protocol population suggest that such a vaccination against nicotine can significantly increase continuous abstinence rates in smokers when sufficiently high antibody levels are achieved. Immunotherapy might open a new avenue to the treatment of nicotine addiction.

Trial registration: Swiss Medical Registry 2003DR2327; ClinicalTrials.gov NCT00369616.

Conflict of interest statement

Competing Interests: P. Müller, J. Willers, M.F. Bachmann, and P. Maurer are Cytos Biotechnology employees. Cytos employees were involved in the following stages of the trial: 1) study design; 2) immunological assays; 3) data analysis and interpretation; 4) writing process; and 5) decision to submit for publication. The corresponding author had full access to all the data, wrote the manuscript and had final editing rights. S. Zwahlen, Y. Bangala and I. Guessous report no conflict of interest. T. Cerny reports having relevant patent rights. J. Cornuz, T. Cerny, and W.F. Jungi report having received travel expenses fees from Cytos Biotechnology.

Figures

Figure 1. Flow Chart of Study Subjects.

Figure 2. Geometric mean nicotine-specific IgG titers (±95% CI) (Active, N = 227; placebo, N = 108).

Figure 3. Nicotine-specific geometric mean IgG titers (±95 confidence interval) in the per protocol population (N = 229).

Figure 4. Point prevalence of smoking abstinence per antibody responder group.

Figure 5. Mean daily number of cigarettes smoked by non-abstainers per antibody responder group at the respective visit.