Effect of antidepressants for cessation therapy in betel-quid use disorder: a randomised, double-blind, placebo-controlled trial

Hung, Chung-Chieh; Lee, Chien-Hung; Ko, Albert Min-Shan; Lane, Hsien‐Yuan; Lee, Chi‐Pin; Ko, Ying‐Chin

doi:10.1017/s2045796020000384

Cited by 20 publications

(11 citation statements)

References 45 publications

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“…The interaction between the follow-up time and SSRI treatment was only significantly decreased at the four-week follow-up. The study of Hung et al demonstrated that a reduction in daily BQ consumption after antidepressant therapy, including MAO-A inhibitors and SSRIs, was observed among patients with depression [ 47 , 48 ]. Our study and previous clinical trials provide preliminary evidence for appropriate treatments for the cessation of AN addiction.…”

Section: Discussionmentioning

confidence: 99%

Reduction in and Preventive Effects for Oral-Cancer Risk with Antidepressant Treatment

Chung

Kuo

Yeh

et al. 2021

JPM

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Areca nut (AN) was identified as carcinogenic to humans. Around 600 million people globally use AN in some form, yet no effective therapeutic drug is available to overcome AN addiction. This preclinical study examines the effects of antidepressants on AN use with animal models. We produced AN powder and dissolved it into drinking water, training 55 C57BL/6 mice in free self-selection to drink AN water or normal water. Then, the mice were randomly divided into four groups. Selective serotonin reuptake inhibitors (SSRIs), monoamine oxidase inhibitors (MAOIs), and tricyclic antidepressants (TCAs) were given as three treatment groups and one placebo group for four weeks. In the follow-up period, the preference and amount of free selection of AN and normal water, and oral pathological change were evaluated. There was a significant decrease in preference for AN drinking during the first four weeks, and the 36th week after drug withdrawal in the MAOI and SSRI groups (all p < 0.05). The drug-reducing effect of AN water in the 1–4-week period was significant in the MAOI group (p < 0.0001) and was also significant in the 3–4-week period in the SSRI group (p = 0.03). The TCA group did not show a decrease effect. At the endpoint (60 weeks), oral mucosal fibrosis (OSF) levels and risk in the SSRI (p = 0.0081) and MAOI (p = 0.01) groups were significantly lower than those in the control group. Antidepressant drugs MAOIs and SSRIs could reduce the amount of AN use and decrease the early stage of oral fibrosis in mice, but SSRIs may need to be boosted again.

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Section: Discussionmentioning

confidence: 99%

Reduction in and Preventive Effects for Oral-Cancer Risk with Antidepressant Treatment

Chung

Kuo

Yeh

et al. 2021

JPM

Self Cite

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“…A limited number of behavioral and pharmacologic interventions to assist cessation of areca nut use have been reported recently ( Moss et al 2015 ; Hung, Lee, Chung, et al 2020 ; Hung, Lee, Ko, et al 2020 ). The total duration of these interventions was far too short to demonstrate any effectiveness on cancer incidence.…”

Section: Evidence For Carcinogenicity Of Areca Nut In Humansmentioning

confidence: 99%

Areca Nut and Oral Cancer: Evidence from Studies Conducted in Humans

Warnakulasuriya

Chen

2022

J Dent Res

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Areca nut chewing is one of the major risk factors for oral cancer, with large-magnitude risks reported in studies comparing betel quid chewers and never users, and it has been evaluated as a group 1 carcinogen by the International Agency for Research on Cancer. Data from a high-quality meta-analysis examining risk estimates are presented in summary form with additional information from more recent studies (pooled adjusted relative risk, 7.9; 95% CI, 7.1 to 8.7). The risk of oral cancer increases in a dose-response manner with the daily number of quids consumed and the number of years chewing. In the Indian subcontinent and in Taiwan, approximately half of oral cancers reported are attributed to betel quid chewing (population attributable fraction, 53.7% for residents in Taiwan and 49.5% for the Indian population), a disease burden that could be prevented. Oral leukoplakia and oral submucous fibrosis are 2 main oral potentially malignant disorders caused by areca nut chewing that can progress to oral cancer with continued use. Ex-chewers seem to demonstrate lower risks than current chewers, but the impact of areca nut cessation on oral cancer risk has not been scientifically evaluated on the basis of randomized controlled studies. These data strongly reconfirm that betel quid chewing, primarily areca nut use, should be taken into account in assessing the cancer risk of South Asian, East Asian populations and Pacific Islanders for the development of oral cancer.

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“…As yet there still are no established areca nut cessation guidelines in populations of patients with areca nut habits, let alone those with OSF. A recent RCT lasting 8 weeks demonstrated that the anti-depressants escitalopram (SSRI) or moclobemide (MAO inhibitor) led to a reduction in betel quid use compared to placebo (Hung et al, 2020). A feasibility study (Moss et al, 2015) has paved the way for an ongoing NIH-funded trial to explore the efficacy of an intensive group-based areca nut cessation program (ClinicalTrials.…”

Section: Or Al Sub Mucous Fib Ros Ismentioning

confidence: 99%

Management of oral potentially malignant disorders

Kerr

Lodi

2021

Oral Diseases

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Patients with oral potentially malignant disorders (OPMDs), including oral leukoplakia and erythroplakia, proliferative verrucous leukoplakia, oral submucous fibrosis, and oral lichen planus/lichenoid lesions, can be challenging to manage. A small proportion will undergo cancer development and determining a patient's cancer risk is key to making management decisions. Yet, our understanding of the natural history of OPMDs has not been fully elucidated, and a precision approach based on the integration of numerous predictive markers has not been validated by prospective studies. Evidence-based health promotion by clinicians and healthcare systems is not embraced universally. Medical and surgical interventions evaluated by rigorous research measuring important endpoints, such as cancer development, mortality, or survival, are difficult and expensive to run. Most of these studies employ non-ideal surrogate endpoints and have deep methodologic flaws. Diagnostic criteria for enrolling research subjects are not uniform, and patients with the highest risk for cancer development comprise small proportions of those enrolled. Few studies explore quality of life and patient preferences. It is time to rethink how we approach the management of these patients, across each OPMD, and considering the healthcare infrastructure and cost-effectiveness. Global networks with well-characterized patient populations with OPMDs and well-designed interventional trials using validated outcome measures are needed.

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Effect of antidepressants for cessation therapy in betel-quid use disorder: a randomised, double-blind, placebo-controlled trial

Cited by 20 publications

References 45 publications

Reduction in and Preventive Effects for Oral-Cancer Risk with Antidepressant Treatment

Reduction in and Preventive Effects for Oral-Cancer Risk with Antidepressant Treatment

Areca Nut and Oral Cancer: Evidence from Studies Conducted in Humans

Management of oral potentially malignant disorders

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