Mechanisms of Lorcaserin for Smoking Cessation

Overview

Identifying new medication options is critical for curbing the health burdens of cigarette smoking. Currently approved smoking cessation medications act on nicotinic receptors, and additional work is needed to identify medications with alternate pharmacological targets. Based on evidence that the serotonin system plays a role in nicotine consumption and relapse, this study will examine whether a selective serotonin medication alters smoking-related behaviors and responses to cigarette smoking under controlled conditions, informing its potential utility for smoking cessation.

Full Title of Study: “Behavioral Mechanisms of Lorcaserin Treatment for Smoking Cessation”

Study Type

  • Study Type: Interventional
  • Study Design
    • Allocation: Randomized
    • Intervention Model: Crossover Assignment
    • Primary Purpose: Basic Science
    • Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
  • Study Primary Completion Date: February 26, 2020

Detailed Description

Tobacco use remains the foremost cause of preventable deaths in the U.S. and worldwide. Advancing new smoking cessation therapies, including those with novel pharmacological targets, is a critical public health priority. The serotonin (5-hydroxtytryptamine; 5-HT) system is broadly implicated in the regulation of reward- related behavior, including drug seeking, in part reflecting its modulatory role in dopamine (DA) function. Recent studies show that targeted manipulation of the serotonin 5-HT2C receptor alters drug-related behavior; in particular, 5-HT2C receptor agonists are shown to reduce nicotine intake and reinstatement. Of the selective 5-HT2C receptor agonists, lorcaserin has the best near-term potential for repurposing as a smoking cessation therapy, having been approved by the U.S. Food and Drug Administration for weight management.

Preclinical findings implicate several potential behavioral mechanisms by which 5-HT2C receptor agonists might reduce drug intake, including drug-specific processes (e.g., incentive salience of drug cues, self-administration, reinstatement) and drug-nonspecific behaviors (e.g., reductions in impulsivity). To date, potential mechanisms of 5-HT2C receptor agonists have not been characterized in human studies. Given emerging interest in lorcaserin as a novel smoking cessation therapy, further studies are needed to evaluate its efficacy profile, including studies to evaluate candidate treatment mechanisms. This human laboratory investigation will examine the effects of lorcaserin vs. placebo on relapse-related outcomes using a double-blind, within-subjects, crossover design. Impulsivity subdomains will also be examined as candidate mechanisms for medication effects. By evaluating an approved 5-HT2C agonist with emergent efficacy for smoking cessation, this project has near-term potential to inform clinical applications of 5-HT2C agonists for addiction.

Interventions

  • Drug: Lorcaserin Oral Tablet
    • Lorcasering 10mg Oral Tablet (BID)
  • Drug: Placebo oral tablet
    • Placebo Oral Tablet (BID)

Arms, Groups and Cohorts

  • Experimental: Lorcaserin
    • Lorcaserin (10mg BID)
  • Placebo Comparator: Placebo
    • Placebo pill (BID)

Clinical Trial Outcome Measures

Primary Measures

  • Smoking lapse
    • Time Frame: Laboratory session following 7 days of medication vs. laboratory session following 7 days of placebo pills (difference score between sessions).
    • Duration (in minutes) until lapsing to smoking during a 50-minute period
  • Laboratory cigarette smoking
    • Time Frame: Laboratory session following 7 days of medication vs. laboratory session following 7 days of placebo pills (difference score between sessions).
    • Number of cigarettes consumed during a 60-minute period

Secondary Measures

  • Impulsivity
    • Time Frame: Laboratory session following 7 days of medication vs. laboratory session following 7 days of placebo pills (difference score between sessions).
    • Performance on a behavioral measure of impulsivity
  • Cigarette craving
    • Time Frame: Laboratory session following 7 days of medication vs. laboratory session following 7 days of placebo pills (difference score between sessions).
    • Self-reported cigarette craving when presented with a cigarette, as measured by the Tiffany Questionnaire of Smoking Urges
  • Subjective cigarette effects
    • Time Frame: Laboratory session following 7 days of medication vs. laboratory session following 7 days of placebo pills (difference score between sessions).
    • Subjective responses to laboratory cigarette smoking, as measured by the Drug Effects Questionnaire.
  • Reward sensitivity
    • Time Frame: Laboratory session following 7 days of medication vs. laboratory session following 7 days of placebo pills (difference score between sessions).
    • Performance on a behavioral measure of reward sensitivity (signal detection task)
  • Daily cigarette smoking
    • Time Frame: During 7 days of medication vs. during 7 days of placebo pills (difference score between weeks).
    • Cigarettes smoked per day

Participating in This Clinical Trial

Inclusion Criteria

1. age 18-65

2. smoking 5+ cigarettes per day (average) over the past year, with no period of abstinence > 90 days

3. biochemical verification of smoking status

4. at least low to moderate nicotine dependence

5. reporting long-term motivation to quit smoking

6. willingness to take study pills and complete study procedures

7. willingness to complete lab sessions involving cigarette smoking

Exclusion Criteria

1. meeting DSM-5 criteria for substance use disorder aside from tobacco use disorder and mild cannabis use disorder

2. recent (30 day) illicit drug use (except marijuana), based on self-report and urine drug screen

3. past 30-day use of tobacco cessation aids or nicotine/tobacco products other than cigarettes

4. past 30-day use of SSRIs, other psychiatric medications, or weight control medications

5. lifetime diagnosis of severe mental illness (e.g., psychotic or bipolar I disorder)

6. significant medical or neurological illness, including severe hepatic impairment or cirrhosis, or insulin dependent diabetes

7. actively engaged in smoking cessation treatments or a smoking cessation attempt (or intent to start an attempt in the next 90 days)

8. interested in quitting smoking immediately (i.e., in the next two months)

9. Medications contraindicated for use with lorcaserin or which have a significant interaction with lorcaserin

10. body mass index (BMI) under normal range (BMI < 18 kg/m2)

11. history of significant cardiovascular conditions including history of arrhythmias or heart block, heart failure, valvular heart disease, heart attack, stroke, unstable angina

12. abnormal electrocardiogram (ECG) results

13. nursing, pregnant, or anticipating pregnancy

14. history of suicide attempt or recent suicidal thoughts (intent or plan) in the last month

15. Plans to travel outside of the local area during the study period, or inability to commit to entire duration of study

Gender Eligibility: All

Minimum Age: 18 Years

Maximum Age: 65 Years

Are Healthy Volunteers Accepted: Accepts Healthy Volunteers

Investigator Details

  • Lead Sponsor
    • The Mind Research Network
  • Provider of Information About this Clinical Study
    • Sponsor
  • Overall Official(s)
    • Christian Hendershot, Ph.D., Principal Investigator, The Mind Research Network
    • Eric Claus, Ph.D., Principal Investigator, The Mind Research Network

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