Thomas R Kosten1, Coreen B Domingo2, Daryl Shorter2, Frank Orson2, Charles Green3, Eugene Somoza4, Rachelle Sekerka4, Frances R Levin5, John J Mariani5, Maxine Stitzer6, D Andrew Tompkins6, John Rotrosen7, Vatsal Thakkar7, Benjamin Smoak7, Kyle Kampman8. 1. Michael E. DeBakey VA Medical Center, Baylor College of Medicine, 2002 Holcombe, Bldg. 121, Rm 141, Houston, TX 77030, United States. Electronic address: Kosten@bcm.edu. 2. Michael E. DeBakey VA Medical Center, Baylor College of Medicine, 2002 Holcombe, Bldg. 121, Rm 141, Houston, TX 77030, United States. 3. University of Texas, Houston, TX 77030, United States. 4. University of Cincinnati, Cincinnati, OH, United States. 5. Columbia University, New York, NY, United States. 6. Johns Hopkins University, Baltimore, MD, United States. 7. NYU/VA NYHHS, New York, NY, United States. 8. University of Pennsylvania, Philadelphia, PA, United States.
Abstract
AIMS: We evaluated the immunogenicity, efficacy, and safety of succinylnorcocaine conjugated to cholera toxin B protein as a vaccine for cocaine dependence. METHODS: This 6-site, 24 week Phase III randomized double-blind placebo-controlled trial assessed efficacy during weeks 8 to 16. We measured urine cocaine metabolites thrice weekly as the main outcome. RESULTS: The 300 subjects (76% male, 72% African-American, mean age 46 years) had smoked cocaine on average for 13 days monthly at baseline. We hypothesized that retention might be better and positive urines lower for subjects with anti-cocaine IgG levels of ≥42 μg/mL (high IgG), which was attained by 67% of the 130 vaccine subjects receiving five vaccinations. Almost 3-times fewer high than low IgG subjects dropped out (7% vs 20%). Although for the full 16 weeks cocaine positive urine rates showed no significant difference between the three groups (placebo, high, low IgG), after week 8, more vaccinated than placebo subjects attained abstinence for at least two weeks of the trial (24% vs 18%), and the high IgG group had the most cocaine-free urines for the last 2 weeks of treatment (OR=3.02), but neither were significant. Injection site reactions of induration and tenderness differed between placebo and active vaccine, and the 29 serious adverse events did not lead to treatment related withdrawals, or deaths. CONCLUSIONS: The vaccine was safe, but it only partially replicated the efficacy found in the previous study based on retention and attaining abstinence.
RCT Entities:
AIMS: We evaluated the immunogenicity, efficacy, and safety of succinylnorcocaine conjugated to cholera toxin B protein as a vaccine for cocaine dependence. METHODS: This 6-site, 24 week Phase III randomized double-blind placebo-controlled trial assessed efficacy during weeks 8 to 16. We measured urine cocaine metabolites thrice weekly as the main outcome. RESULTS: The 300 subjects (76% male, 72% African-American, mean age 46 years) had smoked cocaine on average for 13 days monthly at baseline. We hypothesized that retention might be better and positive urines lower for subjects with anti-cocaine IgG levels of ≥42 μg/mL (high IgG), which was attained by 67% of the 130 vaccine subjects receiving five vaccinations. Almost 3-times fewer high than low IgG subjects dropped out (7% vs 20%). Although for the full 16 weeks cocaine positive urine rates showed no significant difference between the three groups (placebo, high, low IgG), after week 8, more vaccinated than placebo subjects attained abstinence for at least two weeks of the trial (24% vs 18%), and the high IgG group had the most cocaine-free urines for the last 2 weeks of treatment (OR=3.02), but neither were significant. Injection site reactions of induration and tenderness differed between placebo and active vaccine, and the 29 serious adverse events did not lead to treatment related withdrawals, or deaths. CONCLUSIONS: The vaccine was safe, but it only partially replicated the efficacy found in the previous study based on retention and attaining abstinence.
Authors: Thomas R Kosten; Marc Rosen; Julian Bond; Michael Settles; John St Clair Roberts; John Shields; Lindsay Jack; Barbara Fox Journal: Vaccine Date: 2002-01-15 Impact factor: 3.641
Authors: B S Fox; K M Kantak; M A Edwards; K M Black; B K Bollinger; A J Botka; T L French; T L Thompson; V C Schad; J L Greenstein; M L Gefter; M A Exley; P A Swain; T J Briner Journal: Nat Med Date: 1996-10 Impact factor: 53.440
Authors: Marilyn E Carroll; Natalie E Zlebnik; Justin J Anker; Thomas R Kosten; Frank M Orson; Xiaoyun Shen; Berma Kinsey; Robin J Parks; Yang Gao; Stephen Brimijoin Journal: PLoS One Date: 2012-08-17 Impact factor: 3.240
Authors: Kenneth M Carpenter; Paul C Amrhein; Krysten W Bold; Kaitlyn Mishlen; Frances R Levin; Wilfrid N Raby; Suzette M Evans; Richard W Foltin; Edward V Nunes Journal: Exp Clin Psychopharmacol Date: 2016-02-25 Impact factor: 3.157
Authors: Hanna N Wetzel; Rose P Webster; Fatima O Saeed; Terence L Kirley; William J Ball; Andrew B Norman Journal: Biochem Biophys Res Commun Date: 2017-04-23 Impact factor: 3.575
Authors: Suzette M Evans; Richard W Foltin; Martin J Hicks; Jonathan B Rosenberg; Bishnu P De; Kim D Janda; Stephen M Kaminsky; Ronald G Crystal Journal: Pharmacol Biochem Behav Date: 2016-09-30 Impact factor: 3.533