The cure we’ve been waiting for all along?
According to the Centers for Disease Control and Prevention, an estimated 40 million adults smoke cigarettes in the United States alone, rendering it the leading cause of preventable disease and death — cigarettes are responsible for nearly 500,000 deaths per year. There are several therapies and over-the-counter options like nicotine patches, but about 75 percent of smokers report relapsing within six months of attempting to quit.
Now, researchers at the University of Pennsylvania may have a potential option for smokers to quit permanently — FDA-approved medications that are used to improve the cognitive impairments caused by Alzheimer’s disease.
At Penn’s Center for Interdisciplinary Research on Nicotine Addiction, scientists have been working on smoking cessation since 2001, particularly focusing on the effects experienced by people who try to quit smoking.
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"They feel fuzzy. They're forgetful," one of the study researchers Rebecca Ashare said in a press release. "Those deficits are related to their ability to quit smoking. It was this clinical aspect of smoking cessation we thought would be useful to take further."
That's where acetylcholinesterase inhibitors (AChEIs) came in: AChEIs are chemicals that prevent the breakdown of the neurotransmitter acetylcholine. Acetylcholine is important for cognitive functions like short-term memory and learning new things, and when nicotine enters the body, it binds to the same receptors as acetylcholine. This results in the rewarding and reinforcing effects of smoking, so the AChEIs effectively increase acetylcholine levels in the brain and substitute nicotine’s effects.
Ashare and fellow researcher Heath Schmidt conducted a rat trial and a human trial to study the effects of two AChEIs called galantamine and donepezil. They explored the drugs’ effect on overall nicotine intake, and the rat trial showed that AChEI decreased nicotine consumption.
The human trials were equally as promising — participants were either given an AChEI or a placebo, and those who took the AChEI smoked 2.3 fewer cigarettes daily (a 12 percent decrease) and also reported feeling less satisfied with the cigarettes after they did smoke.
The cognitive functions of the study participants were assessed before the trial began as a baseline. For the first two weeks, the participants continued to smoke but either took a placebo or galantamine, and then were asked to not smoke for one full day. Two more assessments took place after the two weeks and after the smoke-free day.
Finally, the researchers asked the volunteers to try their hardest to not smoke for seven days in a row, during which the participants still either took a placebo or galantamine.
"That week-long period is a proxy for longer-term cessation. The ability to quit smoking the first week after you make a quit attempt is highly predictive of long-term success," Ashare said.
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The researchers are still actively recruiting for this smoking cessation trial, aiming to study 80 smokers total. Once they accomplish that, they’ll dig deeper into the overall data. However, so far, they’ve observed that the smokers who used the FDA-approved galantamine smoked fewer cigarettes per day and enjoyed them less, which they say is promising because smokers who don’t smoke during the first crucial week are 32 times more likely to quit smoking permanently.
"Our goal in investigating these different repurposed medications is not to replace the medications that are already available," she said. "We know that they're effective. Our goal is to target different populations of smokers who may be more likely to experience these cognitive deficits."
Until the research is finished, clinicians shouldn’t jump to prescribing smokers AChEIs for cessation treatment. However, the researchers think that this study could potentially provide smokers with a new option to help them quit — given the difficult nature of the task and the high number of people who wish they could quit smoking, there can never be too many options for smoking treatments.
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