Dopamine agonists for the treatment of cocaine dependence - PubMed (original) (raw)

Review

Dopamine agonists for the treatment of cocaine dependence

Silvia Minozzi et al. Cochrane Database Syst Rev. 2015.

Abstract

Background: Cocaine misuse is a disorder for which no pharmacological treatment of proven efficacy exists. Advances in neurobiology could guide future medication development.

Objectives: To investigate the efficacy and acceptability of dopamine agonists alone or in combination with any psychosocial intervention for the treatment of of people who misuse cocaine.

Search methods: We run the search on 12 January 2015. We searched the Cochrane Drugs and Alcohol Group (CDAG) Specialized Register, PubMed, EMBASE, CINAHL, PsycINFO, ICTRP, clinicaltrials.gov and screened reference lists.

Selection criteria: Randomised controlled trials (RCTs) and controlled clinical trials (CCTs) comparing dopamine agonists alone or associated with psychosocial intervention with placebo, no treatment or other pharmacological interventions.

Data collection and analysis: We used standard Cochrane methodological procedures.

Main results: Twenty four studies, including 2147 participants, met the inclusion criteria. Comparing any dopamine agonist versus placebo, we found no differences for any of the outcomes considered: dropout (moderate quality of evidence), abstinence (low quality of evidence), severity of dependence (low quality of evidence), adverse events (moderate quality of evidence). This was also observed when single dopamine agonists were compared against placebo. Comparing amantadine versus antidepressants, we found low quality of evidence that antidepressants performed better for abstinence (RR 0.25, 95% CI 0.12 to 0.53) based on two studies with 44 participants. No differences were found for dropout or adverse events, for both moderate quality of evidence.The major flaws of the included studies concerned selection bias because most studies did not report information about sequence generation (80%) and allocation concealment methods (86%): half of the included studies were judged at unclear risk of performance bias and 62.5% at unclear risk of detection bias for what concerns subjective outcomes.

Authors' conclusions: Current evidence from RCTs does not support the use of dopamine agonists for treating cocaine misuse. This absence of evidence may leave to clinicians the alternative of balancing the possible benefits against the potential adverse effects of the treatment. Even the potential benefit of combining a dopamine agonist with a more potent psychosocial intervention, which was suggested by the previous Cochrane Review (Soares 2003), is not supported by the results of this Cochrane Review update.

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Conflict of interest statement

Silvia Minozzi have no interests to declare relating to this work.

Laura Amato have no interests to declare relating to this work.

Pier Paolo Pani have no interests to declare relating to this work.

Roberta Solimini have no interests to declare relating to this work.

Simona Vecchi have no interests to declare relating to this work.

Franco De Crescenzo have no interests to declare relating to this work.

Pier Giorgio Zuccaro have no interests to declare relating to this work.

Marina davoli have no interests to declare relating to this work.

Figures

1

1

Study flow diagram present update.

2

2

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

3

3

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

4

4

Forest plot of comparison: 1 Any dopamine agonist versus placebo, outcome: 1.1 Dropouts.

5

5

Forest plot of comparison: 1 Any dopamine agonist versus placebo, outcome: 1.2 Adverse events as number of participants with at least one adverse event.

6

6

Forest plot of comparison: 2 Amantadine versus placebo, outcome: 2.2 Adverse events as number of participants with at least one adverse event.

1.1

1.1. Analysis

Comparison 1 Any dopamine agonist versus placebo, Outcome 1 Dropouts.

1.2

1.2. Analysis

Comparison 1 Any dopamine agonist versus placebo, Outcome 2 Adverse events as N of participants with at least one adverse event.

1.3

1.3. Analysis

Comparison 1 Any dopamine agonist versus placebo, Outcome 3 Abstinence (objective).

1.4

1.4. Analysis

Comparison 1 Any dopamine agonist versus placebo, Outcome 4 Abstinence at follow‐up (objective).

1.5

1.5. Analysis

Comparison 1 Any dopamine agonist versus placebo, Outcome 5 Severity of dependence (difference before and after).

1.6

1.6. Analysis

Comparison 1 Any dopamine agonist versus placebo, Outcome 6 Dropouts due to adverse events.

1.7

1.7. Analysis

Comparison 1 Any dopamine agonist versus placebo, Outcome 7 Craving at the end of treatment.

1.8

1.8. Analysis

Comparison 1 Any dopamine agonist versus placebo, Outcome 8 Clinical global evaluation (end of treatment).

1.9

1.9. Analysis

Comparison 1 Any dopamine agonist versus placebo, Outcome 9 Depression (difference before and after).

2.1

2.1. Analysis

Comparison 2 Amantadine versus placebo, Outcome 1 Dropouts.

2.2

2.2. Analysis

Comparison 2 Amantadine versus placebo, Outcome 2 Adverse events as N of participants with at least one adverse event.

2.3

2.3. Analysis

Comparison 2 Amantadine versus placebo, Outcome 3 Abstinence (objective).

2.4

2.4. Analysis

Comparison 2 Amantadine versus placebo, Outcome 4 Abstinence at follow‐up (objective).

2.5

2.5. Analysis

Comparison 2 Amantadine versus placebo, Outcome 5 Severity of dependence (difference before and after).

2.6

2.6. Analysis

Comparison 2 Amantadine versus placebo, Outcome 6 Depression (difference before and after).

3.1

3.1. Analysis

Comparison 3 Bromocriptine versus placebo, Outcome 1 Dropouts.

3.2

3.2. Analysis

Comparison 3 Bromocriptine versus placebo, Outcome 2 Adverse events as N of participants with at least one adverse event.

4.1

4.1. Analysis

Comparison 4 L dopa/carbidopa versus placebo, Outcome 1 Dropouts.

4.2

4.2. Analysis

Comparison 4 L dopa/carbidopa versus placebo, Outcome 2 Dropouts due to adverse events.

4.3

4.3. Analysis

Comparison 4 L dopa/carbidopa versus placebo, Outcome 3 Abstinence (objective).

5.1

5.1. Analysis

Comparison 5 Amantidine versus antidepressants, Outcome 1 Dropouts.

5.2

5.2. Analysis

Comparison 5 Amantidine versus antidepressants, Outcome 2 Adverse events as N of participants with at least one adverse event.

5.3

5.3. Analysis

Comparison 5 Amantidine versus antidepressants, Outcome 3 Abstinence (objective).

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