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New Pharmacological Agents to Aid Smoking Cessation and Tobacco Harm Reduction: What Has Been Investigated, and What Is in the Pipeline?

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Abstract

A wide range of support is available to help smokers to quit and to aid attempts at harm reduction, including three first-line smoking cessation medications: nicotine replacement therapy, varenicline and bupropion. Despite the efficacy of these, there is a continual need to diversify the range of medications so that the needs of tobacco users are met. This paper compares the first-line smoking cessation medications with (1) two variants of these existing products: new galenic formulations of varenicline and novel nicotine delivery devices; and (2) 24 alternative products: cytisine (novel outside Central and Eastern Europe), nortriptyline, other tricyclic antidepressants, electronic cigarettes, clonidine (an anxiolytic), other anxiolytics (e.g. buspirone), selective serotonin reuptake inhibitors, supplements (e.g. St John’s wort), silver acetate, Nicobrevin, modafinil, venlafaxine, monoamine oxidase inhibitors (MAOIs), opioid antagonists, nicotinic acetylcholine receptor (nAChR) antagonists, glucose tablets, selective cannabinoid type 1 receptor antagonists, nicotine vaccines, drugs that affect gamma-aminobutyric acid (GABA) transmission, drugs that affect N-methyl-d-aspartate (NMDA) receptors, dopamine agonists (e.g. levodopa), pioglitazone (Actos; OMS405), noradrenaline reuptake inhibitors and the weight management drug lorcaserin. Six ‘ESCUSE’ criteria—relative efficacy, relative safety, relative cost, relative use (overall impact of effective medication use), relative scope (ability to serve new groups of patients) and relative ease of use—are used. Many of these products are in the early stages of clinical trials; however, cytisine looks most promising in having established efficacy and safety with low cost. Electronic cigarettes have become very popular, appear to be efficacious and are safer than smoking, but issues of continued dependence and possible harms need to be considered.

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Authors and Affiliations

  1. Department of Epidemiology and Public Health, Cancer Research UK Health Behaviour Research Centre, University College London, London, WC1E 6BP, UK

    Emma Beard, Lion Shahab & Robert West

  2. Department of Clinical, Educational and Health Psychology, University College London, London, WC1E 6BP, UK

    Emma Beard & Susan Michie

  3. Department of Neuroscience, Physiology and Pharmacology, University College London, London, WC1E 6BT, UK

    Damian M. Cummings

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  1. Emma Beard
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  2. Lion Shahab
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Correspondence to Emma Beard.

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Conflict of interest

RW undertakes consultancy and research for, and receives travel funds and hospitality from, manufacturers of smoking cessation medications but does not, and will not, take funds from EC manufacturers or the tobacco industry. RW and SM are advisors of the National Centre for Smoking Cessation and Training. EB has received unrestricted funding from Pfizer. LS has received honoraria and reimbursement for expenses for attending and presenting at meetings and workshops from manufacturers of smoking cessation products. He has also received an unrestricted research grant from Pfizer. DMC declares no conflicts of interest.

Funding

RW’s salary is funded by Cancer Research UK (CRUK). EB is funded by CRUK and by the National Institute for Health Research’s (NIHR’s) School for Public Health Research (SPHR). SM is funded by CRUK and the SPHR. The views expressed in this article are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. SPHR is a partnership between the Universities of Sheffield, Bristol, Cambridge and Exeter; UCL; The London School for Hygiene and Tropical Medicine; the LiLaC collaboration between the Universities of Liverpool and Lancaster and Fuse; and The Centre for Translational Research in Public Health, a collaboration between Newcastle, Durham, Northumbria, Sunderland and Teesside Universities. DMC is funded by Alzheimer’s Research UK (ARUK). LS received support from a grant by the former UK Centre for Tobacco Control Studies (UKCTS). Funding from the British Heart Foundation, Cancer Research UK, Economic and Social Research Council, Medical Research Council and the National Institute for Health Research under the auspices of the UK Clinical Research Collaboration is gratefully acknowledged (RES-590-28-0004).

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Beard, E., Shahab, L., Cummings, D.M. et al. New Pharmacological Agents to Aid Smoking Cessation and Tobacco Harm Reduction: What Has Been Investigated, and What Is in the Pipeline?. CNS Drugs 30, 951–983 (2016). https://doi.org/10.1007/s40263-016-0362-3

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