Is Rimonabant a new anti smoking drug?Effects of Rimonabant in the Reduction of Major Cardiovascular Risk Factors. Results from the STRATUS-US Trial (Smoking Cessation in Smokers Motivated to Quit and the RIO-LIPIDS Trial (Weight Reducing and Metabolic Effects in Overweight/Obese Patients with Dyslipidemia).

Rimonabant, a selective cannabinoid type 1 receptor blocker, significantly increases smoking cessation rates and reduces weight gain associated with smoking cessation compared to placebo.

Approximately one-third of coronary heart disease is attributable to smoking. Also, because nicotine is an appetite suppressant, many patients are reluctant to stop smoking due to the associated risk of weight gain.

Repeated nicotine use can overstimulate the endocannabinoid system which regulates food intake and energy balance. The purpose of the Phase III STRATUS-US trial was to evaluate the efficacy of rimonabant in restoring balance to the endocannabinoid system, thus, inhibiting nicotine and food cravings.

A total of 787 smokers wishing to stop smoking were randomized to placebo, or to 5 mg or 20 mg rimonabant once daily. Treatment started 2 weeks prior to smoking cessation and continued for another 8 weeks. Smoking cessation was evaluated during the last 4 weeks of treatment using patient diaries as well as breath carbon monoxide testing and blood levels of nicotine metabolites.

Among patients receiving 20 mg rimonabant, 27.6% were able to stop smoking compared to 15.6% of those taking the 5 mg dose and 16.1% of those taking placebo. (p=0.004, HR 2.2).

In addition, among patients who were not obese at baseline (body mass index less than 30 kg/m2) there was a 77% reduction in post-cessation weight gain compared to placebo. Rimonabant was well tolerated with adverse events occurring in 4.2% of placebo patients, 6.1% of those taking the lower dose, and 6.9% of those taking the 20 mg dose.

In the Rimonabant in Obesity (RIO) Lipids trial, 1036 dyslipidemic patients with central obesity and body mass index ranging from 27 to 40 kg/m2 were randomized to placebo, 5 mg rimonabant daily or 20 mg rimonabant daily for 1 year along with practicing moderate caloric restriction.

After 1 year, those taking the high dose of rimonabant had lost a mean of 20 pounds and 3.4 inches in waist circumference. There was also a 25% increase in HDL cholesterol, a 15% decrease in triglycerides, and a statistically significant reduction in small dense LDL cholesterol.

Importantly, patients taking 20 mg rimonabant daily experienced a 52.9% reduction in terms of meeting the Adult Treatment Panel III criteria for the metabolic syndrome, compared with 25.8% of placebo patients. In addition, there was a 51.9% reduction in the incidence of Type 2 diabetes among patients treated with the high dose of rimonabant versus a 41% reduction among placebo patients.

From:
http://www.acc04online.org/daily/news/newssummary.asp?sid=1&stid=14&newsld=2004-03-09