2006 OPEN FORUM Abstracts
RIMONABANT: A REVIEW OF A NEW DRUG FOR SMOKING CESSATION AND ITS EFFECT ON AN ENDOGENOUS SIGNALING SYSTEM: THE ENDOCANNABINOID SYSTEM
Mary P.
Martinasek, BS, RRT, Robert J. McDermott, PhD
Hillsborough
Community College, Tampa, Florida
University
of South Florida's College of Public Health
Tampa,
Florida
Background: Tobacco
use is one of the most modifiable risk factors associated with chronic lung
disease and premature death, and continues its high ranking among addictive
substances. Tobacco use contributes
to leukemia,
pneumonia and cancer of the pancreas, kidney, cervix, and stomach. Nearly 25%
of adults in the United States use tobacco, and of these,
75% express interest in quitting.
First line therapies have had
limited long-term
success for smoking cessation, even when combined with behavioral therapy.
Recent discovery of a new endogenous signaling system, the endocannabinoid
system,
has brought the new
drug Rimonabant to the forefront, not only as a promising smoking cessation adjuvant,
but also as one to prevent post-cessation
weight gain.
Overactivity
of the endocannabinoid system has been associated with tobacco dependence and
obesity. The endocannabinoid system has two cannabinoid receptors, Cannabinoid
1 (CB1) and Cannabinoid 2 (CB2). The CB1 receptors are located primarily in the brain and have effects on overall
homeostasis, and more specifically,
on tobacco addiction and food intake. Rimonabant was developed as a CB1 blocker working to inhibit overactivity, and subsequently, decrease
tobacco dependence and weight gain.
Methods: A
review of the STRATUS (Studies with Rimonabant and Tobacco Use) study, one
of the largest smoking cessation trials ever conducted in the United States,
shows statistically significant data to support the use of Rimonabant for
smoking cessation. STRATUS is
a double-blinded,
placebo-controlled
study conducted at 11 U.S.
clinical sites, with over 700 smokers
assigned to one of three groups: placebo, 5 mg. Rimonabant, or 20 mg.
Rimonabant for a period of 10 weeks.
Results: Initial
positive results have been shown with Rimonabant in both smoking cessation and
weight control in the United States and Europe.
STRATUS-US has found that Rimonabant doubles the odds of quitting smoking compared
to placebo, with fairly minimal
side effects. A
current worldwide study is now underway involving more than 4000
participants.
Conclusion: Rimonabant holds promise as
a cannabinoid blocker and subsequent weight control medication. With an
international trial currently in progress, Rimonabant is closer to becoming the
next smoking cessation prescription. With current limited successful resources
for smokers, Rimonabant's actions on the endocannabinoid system provide
hope
for tobacco users desiring cessation but fearing weight gain.