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Meta-Analysis
.2013 Sep 2;2013(9):CD009695.
doi: 10.1002/14651858.CD009695.pub2.

Efficacy of psychostimulant drugs for amphetamine abuse or dependence

Affiliations
Meta-Analysis

Efficacy of psychostimulant drugs for amphetamine abuse or dependence

Clara Pérez-Mañá et al. Cochrane Database Syst Rev..

Abstract

Background: Amphetamine dependence is a public health problem with medical, psychiatric, cognitive, legal and socioeconomic consequences. To date, no pharmacological treatment has been approved for this disorder, and psychotherapy remains the mainstay of treatment. In recent years, psychostimulants have been investigated as a possible replacement therapy.

Objectives: To evaluate the efficacy and safety of psychostimulant medications for amphetamine abuse or dependence. The influences of type of drug, type of dependence, comorbid disorders, clinical trial risk of bias and publication of data were also studied.

Search methods: Relevant trials were searched in the following sources: PubMed (January 1966 to 6 June 2012), EMBASE (January 1988 to 6 June 2012), CENTRAL (The Cochrane Library, Issue 5 of 12, May 2012), PsycINFO (January 1985 to 6 June 2012) and the Specialised Register of the Cochrane Drug and Alcohol Group (June 2012). We also searched the reference lists of retrieved trials, the list of studies citing the included trials and the main electronic registers of ongoing trials (ClinicalTrials.gov, International Clinical Trials Registry Platform and EU Clinical Trials Register). Finally, we contacted investigators to request information about unpublished trials. Searches included non-English language literature.

Selection criteria: All randomised, placebo-controlled, parallel-group clinical trials investigating the efficacy or safety of psychostimulants for amphetamine dependence or abuse conducted in an outpatient setting.

Data collection and analysis: We used standard methodological procedures expected by The Cochrane Collaboration.

Main results: Eleven studies were included in the review (791 participants). Studied psychostimulants included dexamphetamine, bupropion, methylphenidate and modafinil. No significant differences were found between psychostimulants and placebo for any of the studied efficacy outcomes. Overall retention in studies was low (50.4%). Psychostimulants did not reduce amphetamine use (mean difference (MD) -0.26, 95% confidence interval (CI) -0.85 to 0.33) or amphetamine craving (MD 0.07, 95% CI -0.44 to 0.59) and did not increase sustained abstinence (relative risk (RR) 1.12, 95% CI 0.84 to 1.49). The proportion of adverse events inducing dropout was similar for psychostimulants and placebo (risk difference (RD) 0.01, 95% CI -0.03 to 0.04). The main findings did not change in any subgroup analysis.

Authors' conclusions: Results of this review do not support the use of psychostimulant medications at the tested doses as a replacement therapy for amphetamine abuse or dependence. Future research could change this conclusion, as the numbers of included studies and participants are limited and information on relevant outcomes, such as efficacy according to the severity of dependence or craving, is still missing.

PubMed Disclaimer

Conflict of interest statement

None.

Figures

1
1
Flow diagram for selection of studies.
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
4
4
Funnel plot of comparison: 1 Psychostimulants vs placebo for amphetamine dependence, outcome: 1.1 Amphetamine use (UA).
5
5
Funnel plot of comparison: 1 Psychostimulants vs placebo for amphetamine dependence, outcome: 1.3 Sustained abstinence.
6
6
Funnel plot of comparison: 1 Psychostimulants vs placebo for amphetamine dependence, outcome: 1.5 Retention in treatment.
7
7
Forest plot of comparison: 8 Post hoc analysis, outcome: 8.1 Amphetamine use (UA).
1.1
1.1. Analysis
Comparison 1 Psychostimulants vs placebo for amphetamine dependence, Outcome 1 Amphetamine use (UA).
1.2
1.2. Analysis
Comparison 1 Psychostimulants vs placebo for amphetamine dependence, Outcome 2 Amphetamine use (hair analysis).
1.3
1.3. Analysis
Comparison 1 Psychostimulants vs placebo for amphetamine dependence, Outcome 3 Sustained abstinence.
1.4
1.4. Analysis
Comparison 1 Psychostimulants vs placebo for amphetamine dependence, Outcome 4 Self‐reported amphetamine use.
1.5
1.5. Analysis
Comparison 1 Psychostimulants vs placebo for amphetamine dependence, Outcome 5 Retention in treatment.
1.6
1.6. Analysis
Comparison 1 Psychostimulants vs placebo for amphetamine dependence, Outcome 6 Amphetamine craving.
1.7
1.7. Analysis
Comparison 1 Psychostimulants vs placebo for amphetamine dependence, Outcome 7 Dropouts due to any adverse event.
1.8
1.8. Analysis
Comparison 1 Psychostimulants vs placebo for amphetamine dependence, Outcome 8 Dropouts due to cardiovascular adverse events.
1.9
1.9. Analysis
Comparison 1 Psychostimulants vs placebo for amphetamine dependence, Outcome 9 Dropouts due to psychiatric adverse events.
2.1
2.1. Analysis
Comparison 2 Subgroup analysis: type of drug, Outcome 1 Amphetamine use (UA).
2.2
2.2. Analysis
Comparison 2 Subgroup analysis: type of drug, Outcome 2 Amphetamine use (hair analysis).
2.3
2.3. Analysis
Comparison 2 Subgroup analysis: type of drug, Outcome 3 Sustained abstinence.
2.4
2.4. Analysis
Comparison 2 Subgroup analysis: type of drug, Outcome 4 Self‐reported amphetamine use.
2.5
2.5. Analysis
Comparison 2 Subgroup analysis: type of drug, Outcome 5 Retention in treatment.
2.6
2.6. Analysis
Comparison 2 Subgroup analysis: type of drug, Outcome 6 Amphetamine craving.
2.7
2.7. Analysis
Comparison 2 Subgroup analysis: type of drug, Outcome 7 Dropouts due to any adverse event.
2.8
2.8. Analysis
Comparison 2 Subgroup analysis: type of drug, Outcome 8 Dropouts due to cardiovascular adverse events.
2.9
2.9. Analysis
Comparison 2 Subgroup analysis: type of drug, Outcome 9 Dropouts due to psychiatric adverse events.
3.1
3.1. Analysis
Comparison 3 Subgroup analysis: type of dependence, Outcome 1 Amphetamine use (UA).
3.2
3.2. Analysis
Comparison 3 Subgroup analysis: type of dependence, Outcome 2 Amphetamine use (hair analysis).
3.3
3.3. Analysis
Comparison 3 Subgroup analysis: type of dependence, Outcome 3 Sustained abstinence.
3.4
3.4. Analysis
Comparison 3 Subgroup analysis: type of dependence, Outcome 4 Self‐reported amphetamine use.
3.5
3.5. Analysis
Comparison 3 Subgroup analysis: type of dependence, Outcome 5 Retention in treatment.
3.6
3.6. Analysis
Comparison 3 Subgroup analysis: type of dependence, Outcome 6 Amphetamine craving.
3.7
3.7. Analysis
Comparison 3 Subgroup analysis: type of dependence, Outcome 7 Dropouts due to any adverse event.
3.8
3.8. Analysis
Comparison 3 Subgroup analysis: type of dependence, Outcome 8 Dropouts due to cardiovascular adverse events.
3.9
3.9. Analysis
Comparison 3 Subgroup analysis: type of dependence, Outcome 9 Dropouts due to psychiatric adverse events.
4.1
4.1. Analysis
Comparison 4 Subgroup analysis: comorbid ADHD as inclusion criterion, Outcome 1 Amphetamine use (UA).
4.2
4.2. Analysis
Comparison 4 Subgroup analysis: comorbid ADHD as inclusion criterion, Outcome 2 Amphetamine use (hair analysis).
4.3
4.3. Analysis
Comparison 4 Subgroup analysis: comorbid ADHD as inclusion criterion, Outcome 3 Sustained abstinence.
4.4
4.4. Analysis
Comparison 4 Subgroup analysis: comorbid ADHD as inclusion criterion, Outcome 4 Self reported amphetamine use.
4.5
4.5. Analysis
Comparison 4 Subgroup analysis: comorbid ADHD as inclusion criterion, Outcome 5 Retention in treatment.
4.6
4.6. Analysis
Comparison 4 Subgroup analysis: comorbid ADHD as inclusion criterion, Outcome 6 Amphetamine craving.
4.7
4.7. Analysis
Comparison 4 Subgroup analysis: comorbid ADHD as inclusion criterion, Outcome 7 Dropouts due to any adverse event.
4.8
4.8. Analysis
Comparison 4 Subgroup analysis: comorbid ADHD as inclusion criterion, Outcome 8 Dropouts due to cardiovascular adverse events.
4.9
4.9. Analysis
Comparison 4 Subgroup analysis: comorbid ADHD as inclusion criterion, Outcome 9 Dropouts due to psychiatric adverse events.
5.1
5.1. Analysis
Comparison 5 Subgroup analysis: data publication, Outcome 1 Amphetamine use (UA).
5.2
5.2. Analysis
Comparison 5 Subgroup analysis: data publication, Outcome 2 Amphetamine use (hair analysis).
5.3
5.3. Analysis
Comparison 5 Subgroup analysis: data publication, Outcome 3 Sustained abstinence.
5.4
5.4. Analysis
Comparison 5 Subgroup analysis: data publication, Outcome 4 Self reported amphetamine use.
5.5
5.5. Analysis
Comparison 5 Subgroup analysis: data publication, Outcome 5 Retention in treatment.
5.6
5.6. Analysis
Comparison 5 Subgroup analysis: data publication, Outcome 6 Amphetamine craving (at the end of study).
5.7
5.7. Analysis
Comparison 5 Subgroup analysis: data publication, Outcome 7 Dropouts due to any adverse event.
5.8
5.8. Analysis
Comparison 5 Subgroup analysis: data publication, Outcome 8 Dropouts due to cardiovascular adverse events.
5.9
5.9. Analysis
Comparison 5 Subgroup analysis: data publication, Outcome 9 Dropouts due to psychiatric adverse events.
6.1
6.1. Analysis
Comparison 6 Subgroup analysis: clinical trial reporting quality (incomplete outcome data), Outcome 1 Amphetamine use (UA).
6.2
6.2. Analysis
Comparison 6 Subgroup analysis: clinical trial reporting quality (incomplete outcome data), Outcome 2 Amphetamine use (hair analysis).
6.3
6.3. Analysis
Comparison 6 Subgroup analysis: clinical trial reporting quality (incomplete outcome data), Outcome 3 Sustained abstinence.
6.4
6.4. Analysis
Comparison 6 Subgroup analysis: clinical trial reporting quality (incomplete outcome data), Outcome 4 Self reported amphetamine use.
6.5
6.5. Analysis
Comparison 6 Subgroup analysis: clinical trial reporting quality (incomplete outcome data), Outcome 5 Retention in treatment.
6.6
6.6. Analysis
Comparison 6 Subgroup analysis: clinical trial reporting quality (incomplete outcome data), Outcome 6 Amphetamine craving.
6.7
6.7. Analysis
Comparison 6 Subgroup analysis: clinical trial reporting quality (incomplete outcome data), Outcome 7 Dropouts due to any adverse event.
6.8
6.8. Analysis
Comparison 6 Subgroup analysis: clinical trial reporting quality (incomplete outcome data), Outcome 8 Dropouts due to cardiovascular adverse events.
6.9
6.9. Analysis
Comparison 6 Subgroup analysis: clinical trial reporting quality (incomplete outcome data), Outcome 9 Dropouts due to psychiatric adverse events.
7.1
7.1. Analysis
Comparison 7 Sensitivity analysis of the safety measures, Outcome 1 Dropouts due to any adverse event.
7.2
7.2. Analysis
Comparison 7 Sensitivity analysis of the safety measures, Outcome 2 Dropouts due to cardiovascular adverse events.
7.3
7.3. Analysis
Comparison 7 Sensitivity analysis of the safety measures, Outcome 3 Dropouts due to psychiatric adverse events.
8.1
8.1. Analysis
Comparison 8 Post hoc analysis, Outcome 1 Amphetamine use (UA).
8.2
8.2. Analysis
Comparison 8 Post hoc analysis, Outcome 2 Amphetamine use (hair analysis).
8.3
8.3. Analysis
Comparison 8 Post hoc analysis, Outcome 3 Sustained abstinence.
8.4
8.4. Analysis
Comparison 8 Post hoc analysis, Outcome 4 Self reported amphetamine use.
8.5
8.5. Analysis
Comparison 8 Post hoc analysis, Outcome 5 Retention in treatment.
8.6
8.6. Analysis
Comparison 8 Post hoc analysis, Outcome 6 Amphetamine craving.
8.7
8.7. Analysis
Comparison 8 Post hoc analysis, Outcome 7 Dropouts due to any adverse event.
8.8
8.8. Analysis
Comparison 8 Post hoc analysis, Outcome 8 Dropouts due to cardiovascular adverse events.
8.9
8.9. Analysis
Comparison 8 Post hoc analysis, Outcome 9 Dropouts due to psychiatric adverse events.
See this image and copyright information in PMC

Update of

References

References to studies included in this review

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Brensilver 2013 {published data only}
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