According to the results of a systematic review and meta-analysis, most pharmacological therapies evaluated for methamphetamine/amphetamine (MA/A) use disorder have not been associated with a statistically significant benefit.
Study authors searched MEDLINE, PsycINFO, Cochrane Library, and ClinicalTrials.gov databases through April 2019 for systematic reviews and randomized controlled trials (RCTs) to evaluate the efficacy of pharmacotherapy for MA/A use disorder. Data from one systematic review and 17 RCTs were pooled for the meta-analysis which included 17 different drugs from various classes (antidepressants, antipsychotics, psychostimulants, anticonvulsants, and opioid antagonists), to assess the quality, publication bias, and overall strength of the evidence. The study outcome measures were sustained abstinence (≥3 consecutive weeks of negative urine drug screens [UDS]), overall use (proportion of MA/A-negative UDS samples), treatment retention (proportion of patients who completed treatment), and adverse reactions.
Results of the study showed that methylphenidate may reduce MA/A use based on low strength evidence from 2 RCTs: mean MA/A-negative UDS was 6.5% for methylphenidate and 2.8% for placebo in one study (N=34, P =.008), and 23% vs 16% in another study (N=54, P =.047). Additionally, moderate strength evidence showed that antidepressant use did not result in a statistically significant effect on abstinence or retention; there was low-strength or insufficient evidence associated with the use of other therapies for MA/A use disorder (ie, anticonvulsants, antipsychotics [aripiprazole], opioid antagonists [naltrexone], varenicline, and atomoxetine). A study involving topiramate showed it was more effective than placebo for reducing MA/A use based on low strength evidence.
According to the results of this meta-analysis, additional studies will need to be conducted to provide further guidance for healthcare professionals. The study authors concluded that “None of the drug classes studied in patients with MA/A use disorder had strong or consistent evidence of benefit on MA/A use, abstinence, or treatment retention. Methylphenidate and topiramate are promising drugs deserving of further study.”
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