Prescription psychostimulants for the treatment of amphetamine-type stimulant use disorder: A systematic review and meta-analysis of randomized placebo-controlled trials

IF 5.2 1区医学 Q1 PSYCHIATRY

Addiction Pub Date : 2023-10-25 DOI:10.1111/add.16347

Heidar Sharafi, Hamzah Bakouni, Christina McAnulty, Sarah Drouin, Stephanie Coronado-Montoya, Arash Bahremand, Paxton Bach, Nadine Ezard, Bernard Le Foll, Christian G. Schütz, Krista J. Siefried, Vitor S. Tardelli, Daniela Ziegler, Didier Jutras-Aswad

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Abstract

Background and Aims

There is currently no standard of care for pharmacological treatment of amphetamine-type stimulant (ATS) use disorder (ATSUD). This systematic review with meta-analysis (PROSPERO CRD42022354492) aimed to pool results from randomized placebo-controlled trials (RCTs) to evaluate efficacy and safety of prescription psychostimulants (PPs) for ATSUD.

Methods

Major indexing sources and trial registries were searched to include records published before 29 August 2022. Eligible studies were RCTs evaluating efficacy and safety of PPs for ATSUD. Risk of bias (RoB) was assessed using the Cochrane RoB 2 tool. Risk ratio (RR) and risk difference were calculated for random-effect meta-analysis of dichotomous variables. Mean difference and standardized mean difference (SMD) were calculated for random-effect meta-analysis of continuous variables.

Results

Ten RCTs (n = 561 participants) were included in the meta-analysis. Trials studied methylphenidate (n = 7), with daily doses of 54–180 mg, and dextroamphetamine (n = 3), with daily doses of 60–110 mg, for 2–24 weeks. PPs significantly decreased end-point craving [SMD −0.29; 95% confidence interval (CI) = −0.55, −0.03], while such a decrease did not reach statistical significance for ATS use, as evaluated by urine analysis (UA) (RR = 0.93; 95% CI = 0.85–1.01). No effect was observed for self-reported ATS use, retention in treatment, dropout following adverse events, early-stage craving, withdrawal and depressive symptoms. In a sensitivity analysis, treatment was associated with a significant reduction in UA positive for ATS (RR = 0.89; 95% CI = 0.79–0.99) after removing studies with a high risk of bias. In subgroup analyses, methylphenidate and high doses of PPs were negatively associated with ATS use by UA, while higher doses of PPs and treatment duration (≥ 20 weeks) were positively associated with longer retention.

Conclusions

Among individuals with amphetamine-type stimulant use disorder, treatment with prescription psychostimulants may decrease ATS use and craving. While effect size is limited, it may increase with a higher dosage of medications.

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治疗苯丙胺类兴奋剂使用障碍的处方精神刺激剂：随机安慰剂对照试验的系统综述和荟萃分析。

背景和目的：目前还没有苯丙胺类兴奋剂（ATS）使用障碍（ATSUD）药物治疗的护理标准。这项荟萃分析系统综述（PROSPERO CRD42022354492）旨在汇集随机安慰剂对照试验（RCTs）的结果，以评估处方精神刺激剂（PPs）治疗ATSUD的疗效和安全性 2022年8月。符合条件的研究是随机对照试验，评估PPs治疗ATSUD的疗效和安全性。使用Cochrane RoB2工具评估偏倚风险（RoB）。对二分变量进行随机效应荟萃分析，计算风险比（RR）和风险差异。计算平均差和标准化平均差（SMD）进行连续变量的随机效应荟萃分析。结果：10项随机对照试验（n = 561名参与者）纳入荟萃分析。哌甲酯（n = 7），每日剂量为54-180 mg和右旋苯丙胺（n = 3），每日剂量为60-110 mg，用于2-24 周。PPs显著降低终点渴求[SMD -0.29；95%置信区间 = -0.55，-0.03]，而根据尿液分析（UA）（RR = 0.93；95%CI = 0.85-1.01）。自我报告的ATS使用、治疗中的滞留、不良事件后的辍学、早期渴望、戒断和抑郁症状均未观察到影响。在敏感性分析中，治疗与UA ATS阳性率显著降低相关（RR = 0.89；95%CI = 0.79-0.99）。在亚组分析中，哌甲酯和高剂量PPs与UA使用ATS呈负相关，而较高剂量PPs和治疗持续时间（≥ 20 周）与更长的滞留时间呈正相关。结论：在苯丙胺类兴奋剂使用障碍患者中，使用处方精神刺激剂治疗可以减少苯丙胺类药物的使用和渴求。虽然效果大小是有限的，但它可能会随着药物剂量的增加而增加。

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来源期刊

Addiction 医学-精神病学

CiteScore

10.80

自引率

6.70%

发文量

319

审稿时长

3 months

期刊介绍： Addiction publishes peer-reviewed research reports on pharmacological and behavioural addictions, bringing together research conducted within many different disciplines. Its goal is to serve international and interdisciplinary scientific and clinical communication, to strengthen links between science and policy, and to stimulate and enhance the quality of debate. We seek submissions that are not only technically competent but are also original and contain information or ideas of fresh interest to our international readership. We seek to serve low- and middle-income (LAMI) countries as well as more economically developed countries. Addiction’s scope spans human experimental, epidemiological, social science, historical, clinical and policy research relating to addiction, primarily but not exclusively in the areas of psychoactive substance use and/or gambling. In addition to original research, the journal features editorials, commentaries, reviews, letters, and book reviews.