|Titre :||Cocaine vaccine for the treatment of cocaine dependence in methadone maintained patients: a randomized double bind placebo controlled efficacity trial|
|Auteurs :||B. A. MARTELL ; F. M. ORSON ; J. POLING ; E. MITCHELL ; R. D. ROSSEN ; T. GARDNER ; T. R. KOSTEN|
|Type de document :||Périodique|
|Année de publication :||2009|
|Note générale :||Archives of General Psychiatry, October 2009, Vol.66, n°10, p.1116-1123|
|Discipline :||TRA (Traitement et prise en charge / Treatment and care)|
Thésaurus TOXIBASECOCAINE ; VACCINATION ; TRAITEMENT ; ETUDE RANDOMISEE ; DEPENDANCE ; TRAITEMENT DE MAINTENANCE ; METHADONE ; ANTICORPS
CONTEXT. Cocaine dependence, which affects 2.5 million Americans annually, has no US Food and Drug Administration–approved pharmacotherapy.
OBJECTIVES. To evaluate the immunogenicity, safety, and efficacy of a novel cocaine vaccine to treat cocaine dependence.
DESIGN. A 24-week, phase 2b, randomized, double-blind, placebo-controlled trial with efficacy assessed during weeks 8 to 20 and follow-up to week 24.
SETTING. Cocaine- and opioid-dependent persons recruited from October 2003 to April 2005 from greater New Haven, Connecticut.
PARTICIPANTS. One hundred fifteen methadone-maintained subjects (67% male, 87% white, aged 18-46 years) were randomized to vaccine or placebo, and 94 subjects (82%) completed the trial. Most smoked crack cocaine along with using marijuana (18%), alcohol (10%), and nonprescription opioids (44%).
Intervention. Over 12 weeks, 109 of 115 subjects received 5 vaccinations of placebo or succinylnorcocaine linked to recombinant cholera toxin B-subunit protein.
MAIN OUTCOME MEASURE. Semiquantitative urinary cocaine metabolite levels measured thrice weekly with a positive cutoff of 300 ng/mL.
RESULTS. The 21 vaccinated subjects (38%) who attained serum IgG anticocaine antibody levels of 43 µg/mL or higher (ie, high IgG level) had significantly more cocaine-free urine samples than those with levels less than 43 µg/mL (ie, low IgG level) and the placebo-receiving subjects during weeks 9 to 16 (45% vs 35% cocaine-free urine samples, respectively). The proportion of subjects having a 50% reduction in cocaine use was significantly greater in the subjects with a high IgG level than in subjects with a low IgG level (53% of subjects vs 23% of subjects, respectively) (P = .048). The most common adverse effects were injection site induration and tenderness. There were no treatment-related serious adverse events, withdrawals, or deaths.
CONCLUSIONS. Attaining high (≥43 µg/mL) IgG anticocaine antibody levels was associated with significantly reduced cocaine use, but only 38% of the vaccinated subjects attained these IgG levels and they had only 2 months of adequate cocaine blockade. Thus, we need improved vaccines and boosters.
|Domaine :||Drogues illicites / Illicit drugs|
|Refs biblio. :||51|
|Affiliation :||Departments of Medicine, Yale University School of Medicine, New Haven, USA|