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Pharmacological Treatment of Methamphetamine/Amphetamine Dependence: A Systematic Review.
CNS Drugs ( IF 6 ) Pub Date : 2020-04-01 , DOI: 10.1007/s40263-020-00711-x
Krista J Siefried 1, 2, 3 , Liam S Acheson 2 , Nicholas Lintzeris 4, 5, 6 , Nadine Ezard 1, 2, 3, 6
Affiliation  

BACKGROUND Stimulant drugs are second only to cannabis as the most widely used class of illicit drug globally, accounting for 68 million past-year consumers. Dependence on amphetamines (AMPH) or methamphetamine (MA) is a growing global concern. Yet, there is no established pharmacotherapy for AMPH/MA dependence. A comprehensive assessment of the research literature on pharmacotherapy for AMPH/MA dependence may inform treatment guidelines and future research directions. METHODS We systematically reviewed the peer-reviewed literature via the electronic databases PubMed, EMBASE, CINAHL and SCOPUS for randomised controlled trials reported in the English language examining a pharmacological treatment for AMPH/MA dependence or use disorder. We included all studies published to 19 June 2019. The selected studies were evaluated for design; methodology; inclusion and exclusion criteria; sample size; pharmacological and (if included) psychosocial interventions; length of follow-up and follow-up schedules; outcome variables and measures; results; overall conclusions and risk of bias. Outcome measures were any reported impact of treatment related to AMPH/MA use. RESULTS Our search returned 43 studies that met our criteria, collectively enrolling 4065 participants and reporting on 23 individual pharmacotherapies, alone or in combination. Disparate outcomes and measures (n = 55 for the primary outcomes) across studies did not allow for meta-analyses. Some studies demonstrated mixed or weak positive signals (often in defined populations, e.g. men who have sex with men), with some variation in efficacy signals dependent on baseline frequency of AMPH/MA use. The most consistent positive findings have been demonstrated with stimulant agonist treatment (dexamphetamine and methylphenidate), naltrexone and topiramate. Less consistent benefits have been shown with the antidepressants bupropion and mirtazapine, the glutamatergic agent riluzole and the corticotropin releasing factor (CRF-1) antagonist pexacerfont; whilst in general, antidepressant medications (e.g. selective serotonin reuptake inhibitors [SSRIs], tricyclic antidepressants [TCAs]) have not been effective in reducing AMPH/MA use. CONCLUSIONS No pharmacotherapy yielded convincing results for the treatment of AMPH/MA dependence; mostly studies were underpowered and had low treatment completion rates. However, there were positive signals from several agents that warrant further investigation in larger scale studies; agonist therapies show promise. Common outcome measures should include change in use days. Future research must address the heterogeneity of AMPH/MA dependence (e.g. coexisting conditions, severity of disorder, differences between MA and AMPH dependence) and the role of psychosocial intervention.

中文翻译:

甲基苯丙胺/苯丙胺依赖的药理治疗:系统评价。

背景技术作为全球使用最广泛的非法药物类别,兴奋剂仅次于大麻,仅次于大麻,占过去一年的6800万消费者。对苯丙胺(AMPH)或甲基苯丙胺(MA)的依赖正在日益引起全球关注。然而,尚无针对AMPH / MA依赖的药物疗法。对药物疗法对AMPH / MA依赖性的研究文献的全面评估可能会为治疗指南和未来研究方向提供参考。方法我们通过电子数据库PubMed,EMBASE,CINAHL和SCOPUS系统地审查了同行评议的文献,这些文献以英语报告了随机对照试验,以检查针对AMPH / MA依赖性或使用障碍的药物治疗。我们纳入了截至2019年6月19日发布的所有研究。方法; 纳入和排除标准;样本量 药理和(如果包括)心理社会干预;随访时间和随访时间表;结果变量和度量;结果; 总体结论和偏见风险。结果指标是与使用AMPH / MA有关的任何治疗影响的报告。结果我们的搜索返回了符合我们标准的43项研究,总共招募了4065名参与者,并单独或联合报告了23种单独的药物疗法。跨研究的不同结果和衡量指标(主要结果为n = 55)不允许进行荟萃分析。一些研究表明阳性信号混合或微弱(通常在特定人群中,例如与男性发生性关系的男性),疗效信号随AMPH / MA使用的基线频率而有所不同。兴奋剂激动剂治疗(右苯丙胺和哌醋甲酯),纳曲酮和托吡酯证明了最一致的阳性结果。抗抑郁药安非他酮和米氮平,谷氨酸能治疗剂利鲁唑和促肾上腺皮质激素释放因子(CRF-1)拮抗剂培克塞方显示出不太一致的益处。通常,抗抑郁药(例如选择性5-羟色胺再摄取抑制剂[SSRI],三环抗抑郁药[TCA])在减少AMPH / MA的使用方面无效。结论没有药物疗法能够令人信服地治疗AMPH / MA依赖性。大多数研究动力不足且治疗完成率低。但是,来自一些代理商的积极信号值得在大规模研究中进一步研究。激动剂疗法显示出希望。共同的结果指标应包括使用天数的变化。未来的研究必须解决AMPH / MA依赖性的异质性(例如,共存条件,疾病严重程度,MA和AMPH依赖性之间的差异)以及社会心理干预的作用。
更新日期:2020-04-01
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