Prescription psychostimulants for the treatment of stimulant use disorder: a systematic review and meta-analysis

Autor:	Thiago M. Fidalgo, Gilberto Gerra, Adam Bisaga, Frances R. Levin, Vitor S. Tardelli, Felipe B. Arcadepani
Rok vydání:	2020
Předmět:	medicine.medical_specialty Prescription Drugs Substance-Related Disorders medicine.medical_treatment media_common.quotation_subject Population Modafinil 03 medical and health sciences 0302 clinical medicine Cocaine Double-Blind Method Internal medicine medicine Humans Lisdexamfetamine Dimesylate education Amphetamine media_common Randomized Controlled Trials as Topic Pharmacology education.field_of_study Methylphenidate business.industry Abstinence medicine.disease Drug Abstinence 030227 psychiatry Stimulant Substance abuse Treatment Outcome Central Nervous System Stimulants business 030217 neurology & neurosurgery medicine.drug
Zdroj:	Psychopharmacology. 237(8)
ISSN:	1432-2072
Popis:	Agonist-based pharmacologic intervention is an accepted approach in treatment of opioid and tobacco use disorders. We conducted a systematic review and meta-analysis to evaluate usefulness of an agonist approach as treatment of (psycho)stimulant use disorder (PSUD). We reviewed PubMed/Medline, LILACS, and ClinicalTrials.gov databases searching for randomized, double-blind, placebo-controlled, parallel-design studies evaluating outcomes of individuals treated for cocaine- or amphetamine-type substance use disorder. We combined results of all trials that included the following prescription psychostimulants (PPs): modafinil, methylphenidate, or amphetamines (mixed amphetamine salts, lisdexamphetamine, and dextroamphetamine). The combined sample consisted of 2889 patients. Outcomes of interest included the following: drug abstinence (defined as 2–3 weeks of sustained abstinence and the average maximum days of consecutive abstinence), percentage of drug-negative urine tests across trial, and retention in treatment. We conducted random-effects meta-analyses and assessed quality of evidence using the GRADE system. Thirty-eight trials were included. Treatment with PPs increases rates of sustained abstinence [risk ratio (RR) = 1.45, 95% confidence interval (CI) = (1.10, 1.92)] and duration of abstinence [mean difference (MD) = 3.34, 95% CI = (1.06, 5.62)] in patients with PSUD, particularly those with cocaine use disorder (very low-quality evidence). Prescription amphetamines were particularly efficacious in promoting sustained abstinence in patients with cocaine use disorder [RR = 2.44, 95% CI = (1.66, 3.58)], and higher doses of PPs were particularly efficacious for treatment of cocaine use disorder [RR = 1.95, 95% CI = (1.38, 2.77)] (moderate-quality evidence). Treatment with prescription amphetamines also yielded more cocaine-negative urines [MD = 8.37%, 95% CI = (3.75, 12.98)]. There was no effect of PPs on the retention in treatment. Prescription psychostimulants, particularly prescription amphetamines given in robust doses, have a clinically significant beneficial effect to promote abstinence in the treatment of individuals with PSUD, specifically the population with cocaine use disorder.
Databáze:	OpenAIRE
Externí odkaz:	https://explore.openaire.eu/search/publication?articleId=doi_dedup___::926849ee14178552466c9adb43cafb90 https://pubmed.ncbi.nlm.nih.gov/32601988 Zobrazit plný text záznamu Plný text ve formátu PDF Plný text ve formátu HTML
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