Efficacy and Safety of NFL-101 as a Smoking Cessation Therapy: A Randomized Phase II Clinical Trial CESTO2
Year: 2025
Type: article
Study designs: Randomized Controlled Trial, Clinical Trial
Abstract: INTRODUCTION: Tobacco addiction remains a major public health challenge. Existing smoking cessation treatments require prolonged daily use with potentially poor adherence and reduced efficacy. METHODS: The phase II study was a multicenter, randomized, double-blind, placebo-controlled trial with a 1-year follow-up to assess the efficacy, safety, and immunogenicity of NFL-101 as a potential aid for smoking cessation. A total of 318 adult daily smokers were randomized to receive subcutaneous injections of NFL-101-100 μg, NFL-101-200 μg, or placebo on day 1 and day 8. The primary outcome was 6-week post-quit 28-day continuous abstinence (CA, day 15-day 43), validated by exhaled CO. RESULTS: CO verified 6-week post-quit CA was: NFL-101-100 μg: 31/108 (28.7%), 200 μg: 23/109 (21.1%), and placebo: 18/101 (17.8%), NFL-101-100 μg vs placebo, RR = 1.61, p = .063, and 200 μg vs placebo RR = 1.18, p = .5492. CA, when urinary cotinine was used, was: 26/108 (24.1%) for NFL-101-100 μg, 18/109 (16.5%) for 200 μg, and 13/101 (12.9%) for placebo. NFL-101-100 μg vs placebo showed an RR = 1.87, 95% confidence interval (CI): 1.02 to 3.44, p = .0378 and 200 μg vs placebo was RR = 1.28, 95%CI: 0.66 to 2.48, p = .4572. If individuals who used NRTs and/or e-cigarettes were classified as non-abstinent, then 29/108 (26.9%) were abstainers for NFL-101-100 μg and 14/101 (13.9%) for placebo (p = .0203). NFL-101-100 μg RR remained stable between 28 days and 12 months. At day 43, NFL-101-100 μg reduced craving (p < .05), with no significant difference for withdrawal symptoms. Abstainers experienced greater increases in anti-NFL-101-IgG concentrations compared to non-abstainers (p < .009). NFL-101 was well-tolerated. CONCLUSIONS: Although the prespecified primary endpoint was not statistically significant, if the primary outcome had been defined as nicotine abstinence, the results would have reached statistical significance. Efficacy, craving reduction, and minimal dosing regimen of NFL-101-100 μg support its potential as a promising smoking cessation therapy. IMPLICATIONS: In this multicenter randomized clinical trial that included 318 smokers, effect sizes between groups were sufficiently large to suggest a meaningful clinical effect. NFL-101 at a dose of 100 μg increased 6-week post-quit 28-day continuous smoking abstinence that was confirmed by urinary cotinine concentrations and reduced craving, suggesting psychological benefits that could mitigate relapse risks. Abstainers experienced a significant increase in anti-NFL-101 IgG concentrations compared to those who continued to smoke.Findings from the present study offer support for an entirely new category of treatment that acts through immune modulation. Additional strengths include a subcutaneous route of administration in the form of two injections spaced a week apart (thus, enhances treatment adherence) and has demonstrated a safe profile with minimal adverse effects. These results support a follow-up phase III clinical trial.
Source: Nicotine & Tobacco Research
DOI: 10.1093/ntr/ntaf181
Authors: Claire Lafay-Chebassier, Pierre-Olivier Girodet, Fabrice Laine, Jean-Sebastien Allain, Gisele Pickering, Mathilde Latreille, Anastasia Demina, Hugues Chevassus, Isabelle Ingrand, Eric Tartour, Nadine Benhamouda, Marie-Laure Fraisse, Liliya Chamitava, Yannick Plétan, Julie Balland, Yves Donazzolo, Bruno Lafont
Institutions: Inserm, Université de Poitiers, Centre Hospitalier Universitaire de Poitiers, Laboratoire de Neurosciences Expérimentales et Cliniques, Université de Bordeaux, Centre Hospitalier Universitaire de Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, Centre d'Investigation Clinique Plurithématique de Bordeaux, CIC Rennes, Hôpital Pontchaillou, Centre Hospitalier Universitaire de Rennes, Centre Hospitalier de Bretagne Sud, Centre Hospitalier Universitaire de Clermont-Ferrand, Université de Bourgogne, CHU Dijon Bourgogne, Cognition, Action, and Sensorimotor Plasticity, Centre Hospitalier Universitaire de Montpellier, Sorbonne Paris Cité, Assistance Publique – Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Paris Cardiovascular Research Center, Université Paris Descartes
Language: English
Subfield: Physiology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $5,392
Award: G3008589337
OpenAlex ID: W4413846138