Smokingmed's Blog

OBESITY TREATMENT Under development by Sanofi-Synthelabo, rimonabant (Acomplia) shows promise as both a weight-loss and smoking-cessation drug. Research indicates that rimonabant significantly reduces abdominal obesity, raises high-density lipoprotein ("good" cholesterol) levels, lowers triglyceride levels, and improves other markers of metabolic syndrome. In one study, obese patients taking rimonabant lost an average of 20 pounds (9 kg) in a year. In a second study, the drug helped smokers nearly double their chances of kicking the habit in 10 weeks-and, as a bonus, overweight subjects also dropped about a pound each. The most common adverse reactions were nausea, dizziness, and upper respiratory tract infections. Rimonabant is the first of a new class of drugs that block certain receptors on brain and fat cells belonging to the endocannabinoid (EC) system. Nicotine and the active ingredient in marijuana both attach to EC system receptors. Blocking these receptors seems to reduce both appetite and the urge to smoke.

Rimonabant is a first-in-class cannabinoid type 1 (CB1) receptor blocker discovered and developed by sanofi-Aventis. In Europe, rimonabant, known as ACOMPLIA® is approved as an adjunct to diet and exercise for the treatment of obese patients (BMI greater than or equal to 30kg/m2), or overweight patients (BMI27kg/m2) with associated risk factors, such as type 2 diabetes or dyslipidaemia. Rimonabant is currently commercialized in the United Kingdom, Germany, Denmark, Sweden, Finland, Norway, Ireland, Argentina and Austria.

Chantix (varenicline) can be four times as effective in helping a smoker give up cigarettes successfully, according to a report in JAMA (Journal of the American Medical Association), 5 July. According to the report, which cites three studies, Chantix is twice as effective as Zyban (bupropion).

The chances of having a relapse during the first six months after giving up are significantly reduced when a smoker is on Chantix, according to one study.

Chantix was approved by the FDA in May, 2006.

All the studies were funded by the makers of Chantix, Pfizer. A JAMA editorial is sceptical of all the hype surrounding this new smoking cessation drug. Robert Klesges, University of Tennessee Health Science Center, Memphis, USA, says enthusiasm for a new smoking-cessation drug is always high when it first comes onto the market. Even though Chantix has better results than either a placebo or Zyban, this does not necessarily mean it is the holy grail for smoking addicts.

Chantix works in a different way from Zyban or nicotine-replacement therapies. Nicotine-replacement therapies give you a small dose of nicotine - the aim is to provide the smoker with his/her drug while he/she overcomes the enormous psychological problems that come with giving up. Zyban undermines the reuptake of addiction-linked brain chemicals by neurons - dopamanine and norepinephrine. Chantix makes the patient produce more dopamine, which is supposed to help lower the cravings - at the same time brain cell receptors that help perpetuate addiction are blocked.

One study included 1,025 volunteers, all of them smokers who wanted to quit. Chantix, Zyban and a placebo were compared. The study lasted one year. Here are some facts from that study:

-- 44% of those on Chantix were not smoking at 12 weeks
-- 29.5%% of those on Zyban were not smoking at 12 weeks
-- 18% of those on a placebo were not smoking at 12 weeks
-- 22% of those on Chantix did not smoke from week 9 to 52
-- 16% of those on Zyban did not smoke from week 9 to 52
-- 8.4% of those on a placebo did not smoke from week 9 to 52

Another study, from the Unversity of Wisconsin included 1,027 volunteers, all of them smokers who wanted to quit. Results were almost the same as the ones above.

The third study involved people in seven countries - 1,900 smokers who wanted to quit. All of them took Chantix for the first 12 weeks, after which 1,236 (65%) were still not smoking. The 1,236 quitters were then divided into two groups: One group continued taking Chantix while the other took a placebo. This continued for another 12 weeks. At the end of the 24-week period:

-- 70.5% of those on Chantix were not smoking
-- 49.6% of those on a placebo were not smoking

After one year a significantly higher number of those who had been on Chantix were still not smoking compared to those on a placebo.

Chantix has some side effects, which were experienced by about one third of all the volunteers. They included nausea and strange dreams.

Scientists say that the Pfizer funded trials were carried out in ideal conditions for the participant - there was lots of support. Perhaps results may not be as encouraging when a patient gets a prescription from the doctor and is then left to his/own devices.

Even in this third study, which started with 1,900 volunteers, medication and plenty of support, only 871 were not smoking after 24 weeks - less than half.

A new, and potentially effective drug, to help cigarette smokers quit smoking has been fast tracked for approval by the U.S. Food and Drug Administration. Chantix, varenicline tartrate, works in ways that previous smoking cessation drugs did not, and might lead to a higher success rate where the other drugs have failed. Chantix acts at the areas of the brain affected by nicotine and helps those who smoke cigarettes to quit smoking in two ways: by providing some nicotine effects to ease the withdrawal symptoms and by blocking the effects of nicotine from cigarettes if they start smoking again. "Cigarette smoking is a very difficult habit to break due in large part to nicotine dependence or addiction," said Dr. Steven Galson, Director of FDA's Center for Drug Evaluation and Research. "Chantix therapy has proven to be effective in smokers motivated to quit and will provide another tool for physicians to use for the millions of smokers who want to quit." According to the Centers for Disease Control and Prevention, an estimated 44.5 million adults in the United States smoke cigarettes and more than 8.6 million of them have at least one serious illness caused by smoking. Chantix should be available later this year. I think the operative word here is motivated to quit smoking. Addiction is a complex physical, mental, emotional and spiritual problem. A magic pill to make the addiction go away would be nice. I am not so sure I believe in that kind of magic -- although I am relatively certain it will help some smokers quit smoking.