How can we investigate the role of topiramate in the treatment of cocaine use disorder more thoroughly?

Klimas, Jan; Wood, Evan; Werb, Dan

doi:10.1111/add.13618

Cited by 2 publications

(2 citation statements)

References 10 publications

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“…78 The combination of pharmacotherapy with CM is an important area for future research as we do not know how medication may enhance the effectiveness of these interventions. 79,80 When we compared studies with a CM co-intervention to those without, we found that pharmacotherapeutic effects were similar in both. 81 Our SR has several limitations.…”

Section: Discussionmentioning

confidence: 96%

Pharmacotherapy for Cocaine Use Disorder—a Systematic Review and Meta-analysis

et al. 2019

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BACKGROUND: Currently, there are no accepted FDAapproved pharmacotherapies for cocaine use disorder, though numerous medications have been tested in clinical trials. We conducted a systematic review and metaanalysis to better understand the effectiveness of pharmacotherapy for cocaine use disorder. METHODS: We searched multiple data sources (MEDLINE, PsycINFO, and Cochrane Library) through November 2017 for systematic reviews and randomized controlled trials (RCTs) of pharmacological interventions in adults with cocaine use disorder. When possible, we combined the findings of trials with comparable interventions and outcome measures in random-effects metaanalyses. We assessed the risk of bias of individual trials and the strength of evidence for each outcome using standardized criteria. Outcomes included continuous abstinence (3+ consecutive weeks); cocaine use; harms; and study retention. For relapse prevention studies (participants abstinent at baseline), we examined lapse (first cocaine positive or missing UDS) and relapse (two consecutive cocaine positive or missed UDS′). RESULTS: Sixty-six different drugs or drug combinations were studied in seven systematic reviews and 48 RCTs that met inclusion criteria. Antidepressants were the most widely studied drug class (38 RCTs) but appear to have no effect on cocaine use or treatment retention. Increased abstinence was found with bupropion (2 RCTs: RR 1.63, 95% CI 1.02 to 2.59), topiramate (2 RCTs: RR 2.56, 95% CI 1.39 to 4.73), and psychostimulants (14 RCTs: RR 1.36, 95% CI 1.05 to 1.77), though the strength of evidence for these findings was low. We found moderate strength of evidence that antipsychotics improved treatment retention (8 RCTs: RR 1.33, 95% CI 1.03 to 1.75). DISCUSSION: Most of the pharmacotherapies studied were not effective for treating cocaine use disorder. Bupropion, psychostimulants, and topiramate may improve abstinence, and antipsychotics may improve retention. Contingency management and behavioral interventions along with pharmacotherapy should continue to be explored.

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Section: Discussionmentioning

confidence: 96%

Pharmacotherapy for Cocaine Use Disorder—a Systematic Review and Meta-analysis

et al. 2019

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“…A meta-analysis conducted by Minozzi et al (2015a) concluded anticonvulsants are not helpful but there were only a handful of topiramate studies included; the results of these trials were mixed with three positive trials, one clearly negative study conducted in a methadone maintenance population (Umbricht et al, 2014), a population that is often nonresponsive to cocaine treatment interventions and another negative trial that used a fast titration (Nuitjen et al, 2014) leading to high dropouts. Klimas et al (2017) concluded that this heterogeneity impedes drawing any conclusions regarding topiramate's efficacy or the utility in using a meta-analytic approach. Given the limitations of the 2 negative trials, topiramate may have therapeutic utility for cocaine use disorder.…”

Section: Discussionmentioning

confidence: 99%

Extended release mixed amphetamine salts and topiramate for cocaine dependence: A randomized clinical replication trial with frequent users

Levin¹,

Mariani²,

Pavlicová

et al. 2020

Drug and Alcohol Dependence

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Background-Cocaine use disorder (CUD) remains a substantial public health problem with no clearly effective pharmacotherapy available. In a prior trial, combined amphetamine and topiramate treatment significantly reduced cocaine use among individuals demonstrating the most frequent use at baseline. This trial targeted such frequent users.Methods-A double-blind, randomized placebo-controlled trial, testing the combination of mixed amphetamine salts extended-release (MAS-ER) and topiramate or placebo over a 12-week medication phase was conducted. The two-site outpatient trial included 127 adults (96 males

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How can we investigate the role of topiramate in the treatment of cocaine use disorder more thoroughly?

Cited by 2 publications

References 10 publications

Pharmacotherapy for Cocaine Use Disorder—a Systematic Review and Meta-analysis

Pharmacotherapy for Cocaine Use Disorder—a Systematic Review and Meta-analysis

Extended release mixed amphetamine salts and topiramate for cocaine dependence: A randomized clinical replication trial with frequent users

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