Cannabinoid type 1 receptor antagonists for smoking cessation

• Published in: Cochrane database of systematic reviews 2011-03, Vol.2011 (3), p.CD005353
• Main Authors: Cahill, Kate, Ussher, Michael H
• Format: Article
• Language: English
• Subjects: Amides - adverse effects; Amides - therapeutic use; Body Weight - drug effects; Humans; Interventions to help smokers and other tobacco users to quit; Lungs & airways; Piperidines - adverse effects; Piperidines - therapeutic use; Pyrazoles - adverse effects; Pyrazoles - therapeutic use; Pyridines - adverse effects; Pyridines - therapeutic use; Randomized Controlled Trials as Topic; Receptor, Cannabinoid, CB1 - antagonists & inhibitors; Rimonabant; Secondary Prevention; Smoking - drug therapy; Smoking Cessation; Smoking Prevention; Tobacco, drugs & alcohol
• ISSN: 1469-493X; 1469-493X
• DOI: 10.1002/14651858.CD005353.pub4

Selective type 1 cannabinoid (CB1) receptor antagonists may assist with smoking cessation by restoring the balance of the endocannabinoid system, which can be disrupted by prolonged use of nicotine. They also seeks to address many smokers' reluctance to persist with a quit attempt because of concerns about weight gain. To determine whether selective CB1 receptor antagonists (currently rimonabant and taranabant) increase the numbers of people stopping smoking To assess their effects on weight change in successful quitters and in those who try to quit but fail. We searched the Cochrane Tobacco Addiction Review Group specialized register for trials, using the terms ('rimonabant' or 'taranabant') and 'smoking' in the title or abstract, or as keywords. We also searched MEDLINE, EMBASE, CINAHL and PsycINFO, using major MESH terms. We acquired electronic or paper copies of posters of preliminary trial results presented at the American Thoracic Society Meeting in 2005, and at the Society for Research on Nicotine and Tobacco European Meeting 2006. We also attempted to contact the authors of ongoing studies of rimonabant, and Sanofi Aventis (manufacturers of rimonabant). The most recent search was in January 2011. Types of studies Randomized controlled trialsTypes of participants Adult smokersTypes of interventions Selective CB1 receptor antagonists, such as rimonabant and taranabant. Types of outcome measures The primary outcome is smoking status at a minimum of six months after the start of treatment. We preferred sustained cessation rates to point prevalence, and biochemically verified cessation to self-reported quitting. We regarded smokers who drop out or are lost to follow up as continuing smokers. We have noted any adverse effects of treatment.A secondary outcome is weight change associated with the cessation attempt. Two authors checked the abstracts for relevance, and attempted to acquire full trial reports. One author extracted the data, and a second author checked them. We found three trials which met our inclusion criteria, covering 1567 smokers (cessation: STRATUS-EU and STRATUS-US), and 1661 quitters (relapse prevention: STRATUS-WW). At one year, the pooled risk ratio (RR) for quitting with rimonabant 20 mg was 1.50 (95% confidence interval (CI) 1.10 to 2.05). No significant benefit was demonstrated for rimonabant at 5 mg dosage. Adverse events included nausea and upper respiratory tract infections. In the relapse prevention trial, smokers who had quit