Atomoxetine for amphetamine-type stimulant dependence during buprenorphine treatment: A randomized controlled trial

Schottenfeld, Richard S.; Sofuoglu, Mehmet; Chooi, Weng-Tink; Zaharim, Norzarina Mohd; Yasin, Mohd Azhar Mohd; Ahmad, Imran; Jaapar, Sharifah Zubaidiah Syed; Vicknasingam, Balasingam

doi:10.1016/j.drugalcdep.2018.01.017

Cited by 8 publications

(9 citation statements)

References 64 publications

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“…The proportion of ATS-negative UDS was higher in the atomoxetine arm compared with placebo, but achieved only a small effect size, while there was no statistically significant difference in days abstinent. For secondary outcomes, the proportion of morphine-negative UDS was lower for the atomoxetine arm, while the depression scores were significantly reduced in the atomoxetine arm compared with placebo [58].…”

Section: Antidepressantsmentioning

confidence: 94%

“…Of the 4065 participants reported on in the reviewed studies, 2858 (70.3%) were male. Nine of the 43 studies (21%) enrolled only males [24,29,30,34,46,52,55,57,58], however not all of these were by design. One study [45] did not report the sample by those randomised, only by completers (in a non-intention-to-treat analysis) and so the total randomised figure of men versus women was not able to be determined based on randomisation (authors did not respond to a request for further data).…”

Section: Study Selection and Characteristicsmentioning

confidence: 99%

“…Thirty of the 43 studies (69.8%) included participants dependent on MA only [24-30, 32-35, 38-41, 44, 45, 47-50, 53-55, 57, 59-62, 65]; four (9.3%) were on MA/ AMPH [31,37,51,64]; four (9.3%) were on AMPH only [42,43,46,56]; three (7.0%) were on amphetamine-type stimulants (ATS) and opioids [52,58,63] and two (4.7%) were on MA/cocaine [36,66].…”

Section: Study Selection and Characteristicsmentioning

confidence: 99%

“…Females were underrepresented in the data, being only 29.7% of the total participants. This comprises both studies that only enrolled males (nine studies, 21%) [24,29,30,34,46,52,55,57,58] and those enrolling both males and females but with higher male enrolments. Thirty-four (79.1%) of the studies we reviewed excluded participants with depression or psychotic disorders, or those taking an antidepressant or antipsychotic medication.…”

Section: Risk Of Bias Within and Across Studiesmentioning

confidence: 99%

“…A study of atomoxetine (80 mg po OD), a selective norepinephrine (noradrenaline) reuptake inhibitor (SNRI), randomised 69 opioid and ATS-dependent participants to 16 weeks of treatment, assessing ATS use as the primary outcome [58]. The proportion of ATS-negative UDS was higher in the atomoxetine arm compared with placebo, but achieved only a small effect size, while there was no statistically significant difference in days abstinent.…”

Section: Antidepressantsmentioning

confidence: 99%

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Pharmacological Treatment of Methamphetamine/Amphetamine Dependence: A Systematic Review

et al. 2020

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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.

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Section: Antidepressantsmentioning

confidence: 94%