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01-12-2019 | Antidepressant Drugs | Review

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

Authors: Brian Chan, MD MPH, Karli Kondo, PhD MA, Michele Freeman, MPH, Chelsea Ayers, BA, Jessica Montgomery, MPH, Devan Kansagara, MD MCR

Published in: Journal of General Internal Medicine | Issue 12/2019

Abstract

Background

Currently, there are no accepted FDA-approved pharmacotherapies for cocaine use disorder, though numerous medications have been tested in clinical trials. We conducted a systematic review and meta-analysis 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 meta-analyses. 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.

SR Registration

Prospero CRD42018085667

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Title: Pharmacotherapy for Cocaine Use Disorder—a Systematic Review and Meta-analysis
Authors: Brian Chan, MD MPH
Karli Kondo, PhD MA
Michele Freeman, MPH
Chelsea Ayers, BA
Jessica Montgomery, MPH
Devan Kansagara, MD MCR
Publication date: 01-12-2019
Publisher: Springer US
Keywords: Antidepressant Drugs
Opioids
Opioids
Antipsychotics
Antidepressant Drugs
Bupropion
Antipsychotics
Topiramate
Published in: Journal of General Internal Medicine / Issue 12/2019
Print ISSN: 0884-8734
Electronic ISSN: 1525-1497
DOI: https://doi.org/10.1007/s11606-019-05074-8

Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

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Year in Review: Valvular heart disease

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Year in Review: Heart failure and cardiomyopathies

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Watch this official video from ACC.24. Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

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New intervention for STEMI-related cardiogenic shock

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Image Credits

STEP AAG HeroTeaserCollection image/© Tarek / Generated with AI / Stock.adobe.com, ACC 2024 Pediatric and Congenital Heart Disease: Year in Review/© 2024 American College of Cardiology, ACC 2024 Pulmonary Vascular Disease: Year in Review/© 2024 American College of Cardiology, ACC 2024 Valvular Heart Disease: Year in Review/© 2024 American College of Cardiology, ACC 2024 HF and Cardiomyopathies: Year in Review/© 2024 American College of Cardiology, Woman out walking/© Seventyfour / stock.adobe.com (symbolic image with model), Woman checking smartwatch /© saltdium / stock.adobe.com (symbolic image with model), Cardiac catheterization/© Damian / stock.adobe.com

At a glance: The STEP trials

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Methods

Results

Discussion

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Screening for Substance Use in Rural Primary Care: a Qualitative Study of Providers and Patients

Training Primary Care Physicians to Serve Underserved Communities: Follow-up Survey of Primary Care Graduates

From the Editors’ Desk: Peer Review at JGIM

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Low Awareness of Nonalcoholic Fatty Liver Disease in a Population-Based Cohort Sample: the CARDIA Study

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