Cocaine dependence vaccines

More than 40 medications have been investigated but none have shown consistent efficacy for primary cocaine or amphetamine dependence. These medications include dopaminergic agonists, antidepressants, and more recently disulfiram, selegiline, and a cocaine vaccine (see Table 5—2 for summary). Studies have been relatively brief and have focused on abstinence initiation rather than on relapse prevention, but even these modest treatment goals have not been attained. The focus in the discussion that follows is on pharmacotherapies for cocaine dependence, because very few clinical trials have been completed with amphetamine-dependent patients. Furthermore, none of the studies of amphetamine dependence have shown results different from those described for cocaine dependence (Rawson et al. 2002b Srisurapanont et al. 2001). 

An alternative pharmacotherapy for cocaine dependence currently under investigation is use of a cocaine vaccine to blunt the reinforcing effects of cocaine.51 60 The basis of this pharmacotherapy is to decrease the rate of entry of cocaine into the CNS (and therefore the onset of action), by either binding cocaine with antibody generated by active immunization with a stable cocaine conjugate or by using an enzymatically active antibody specific for cocaine. 

Martell B.A., Mitchell E., Poling J., Gonsai K., Kosten T.R. Vaccine pharmacotherapy for the treatment of cocaine dependence. Biol. Psychiatry. 58 158, 2005. 

Vaccines have been tested as a potential pharmacotherapy for cocaine addiction. A cocaine vaccine (Table 1) of succinyl norco-caine conjugated to the cholera toxin (TA-CD) was administered to cocaine-dependent individuals [86], Individuals who produced adequate antibody levels showed reduced cocaine use. Genetic analysis showed that T allele carriers of variant rsl611115 (which has been shown to be associated with low DpH expression) reduced cocaine use with vaccine, while subjects with the CC genotype did not [87]. This may be related to the increase incidence of paranoia while using cocaine in subjects with the low expressing DBH genotype [80]. 

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