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Pharmacological treatment for methamphetamine withdrawal: A systematic review and meta‐analysis of randomised controlled trials

ISSUES: Cessation of methamphetamine use may result in a characteristic withdrawal syndrome, no medication has been approved for this indication. This systematic review aims to assess the efficacy of pharmacotherapy for methamphetamine withdrawal, the first comprehensive meta‐analysis since 2008. AP...

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Autores principales: Acheson, Liam S., Williams, Benjamin H., Farrell, Michael, McKetin, Rebecca, Ezard, Nadine, Siefried, Krista J.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley & Sons Australia, Ltd 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10083934/
https://www.ncbi.nlm.nih.gov/pubmed/35862266
http://dx.doi.org/10.1111/dar.13511
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author Acheson, Liam S.
Williams, Benjamin H.
Farrell, Michael
McKetin, Rebecca
Ezard, Nadine
Siefried, Krista J.
author_facet Acheson, Liam S.
Williams, Benjamin H.
Farrell, Michael
McKetin, Rebecca
Ezard, Nadine
Siefried, Krista J.
author_sort Acheson, Liam S.
collection PubMed
description ISSUES: Cessation of methamphetamine use may result in a characteristic withdrawal syndrome, no medication has been approved for this indication. This systematic review aims to assess the efficacy of pharmacotherapy for methamphetamine withdrawal, the first comprehensive meta‐analysis since 2008. APPROACH: MEDLINE (1966–2020), CINAHL (1982–2020), PsychINFO (1806–2020) and EMBASE (1947–2020) were systematically searched. Studies were included if they were randomised controlled trials (RCT) investigating pharmacological treatments for methamphetamine withdrawal, reviewing outcomes of treatment discontinuation, mental health outcomes, withdrawal symptoms (including craving) and patient safety. The relative risk (RR) and weighted mean difference (MD) were used to meta‐analyse dichotomous and continuous data respectively, with 95% confidence intervals. Risk of bias and Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) assessments were conducted. KEY FINDINGS: Nine RCTs of six medications (n = 242 participants) met inclusion criteria, however, only six trials of four medications (n = 186) could be meta‐analysed. Mean sample size across studies was 27 participants, and 88% of participants were male. The quality of evidence in this review varies from low to very low on GRADE assessments. Amineptine may reduce discontinuation rates (RR 0.22, 95% confidence interval [CI] 0.07, 0.72, p = 0.01), and improve global state (MD −0.49, 95% CI −0.80, −0.17), compared with placebo, however, this medication is no longer approved. No other medications improved any domain when compared with placebo. Due to lack of reporting safety profiles could not be established. CONCLUSIONS: There is insufficient evidence to indicate any medication is effective for the treatment of methamphetamine withdrawal. The poor quality of the evidence indicates a need for better powered, high‐quality trials.
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spelling pubmed-100839342023-04-11 Pharmacological treatment for methamphetamine withdrawal: A systematic review and meta‐analysis of randomised controlled trials Acheson, Liam S. Williams, Benjamin H. Farrell, Michael McKetin, Rebecca Ezard, Nadine Siefried, Krista J. Drug Alcohol Rev Comprehensive Review ISSUES: Cessation of methamphetamine use may result in a characteristic withdrawal syndrome, no medication has been approved for this indication. This systematic review aims to assess the efficacy of pharmacotherapy for methamphetamine withdrawal, the first comprehensive meta‐analysis since 2008. APPROACH: MEDLINE (1966–2020), CINAHL (1982–2020), PsychINFO (1806–2020) and EMBASE (1947–2020) were systematically searched. Studies were included if they were randomised controlled trials (RCT) investigating pharmacological treatments for methamphetamine withdrawal, reviewing outcomes of treatment discontinuation, mental health outcomes, withdrawal symptoms (including craving) and patient safety. The relative risk (RR) and weighted mean difference (MD) were used to meta‐analyse dichotomous and continuous data respectively, with 95% confidence intervals. Risk of bias and Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) assessments were conducted. KEY FINDINGS: Nine RCTs of six medications (n = 242 participants) met inclusion criteria, however, only six trials of four medications (n = 186) could be meta‐analysed. Mean sample size across studies was 27 participants, and 88% of participants were male. The quality of evidence in this review varies from low to very low on GRADE assessments. Amineptine may reduce discontinuation rates (RR 0.22, 95% confidence interval [CI] 0.07, 0.72, p = 0.01), and improve global state (MD −0.49, 95% CI −0.80, −0.17), compared with placebo, however, this medication is no longer approved. No other medications improved any domain when compared with placebo. Due to lack of reporting safety profiles could not be established. CONCLUSIONS: There is insufficient evidence to indicate any medication is effective for the treatment of methamphetamine withdrawal. The poor quality of the evidence indicates a need for better powered, high‐quality trials. John Wiley & Sons Australia, Ltd 2022-07-21 2023-01 /pmc/articles/PMC10083934/ /pubmed/35862266 http://dx.doi.org/10.1111/dar.13511 Text en © 2022 The Authors. Drug and Alcohol Review published by John Wiley & Sons Australia, Ltd on behalf of Australasian Professional Society on Alcohol and other Drugs. https://creativecommons.org/licenses/by/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
spellingShingle Comprehensive Review
Acheson, Liam S.
Williams, Benjamin H.
Farrell, Michael
McKetin, Rebecca
Ezard, Nadine
Siefried, Krista J.
Pharmacological treatment for methamphetamine withdrawal: A systematic review and meta‐analysis of randomised controlled trials
title Pharmacological treatment for methamphetamine withdrawal: A systematic review and meta‐analysis of randomised controlled trials
title_full Pharmacological treatment for methamphetamine withdrawal: A systematic review and meta‐analysis of randomised controlled trials
title_fullStr Pharmacological treatment for methamphetamine withdrawal: A systematic review and meta‐analysis of randomised controlled trials
title_full_unstemmed Pharmacological treatment for methamphetamine withdrawal: A systematic review and meta‐analysis of randomised controlled trials
title_short Pharmacological treatment for methamphetamine withdrawal: A systematic review and meta‐analysis of randomised controlled trials
title_sort pharmacological treatment for methamphetamine withdrawal: a systematic review and meta‐analysis of randomised controlled trials
topic Comprehensive Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10083934/
https://www.ncbi.nlm.nih.gov/pubmed/35862266
http://dx.doi.org/10.1111/dar.13511
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