Pharmacotherapy for Cocaine Use Disorder-a Systematic Review and Meta-analysis.
Level 1 - systematic review of randomized trials
Systematic review and meta-analysis of randomized controlled trials
PubMed 31183685 · doi:10.1007/s11606-019-05074-8
What was done
Authors searched MEDLINE, PsycINFO, and Cochrane Library through November 2017 for systematic reviews and randomized controlled trials (RCTs) evaluating pharmacotherapies in adults with cocaine use disorder. When feasible, random-effects meta-analyses were conducted. Key outcomes assessed were continuous abstinence (at least 3 consecutive weeks), cocaine use, harms, study retention, and lapse or relapse in relapse-prevention studies. Risk of bias and strength of evidence were evaluated using standardized criteria.
What was found
Across 7 systematic reviews and 48 RCTs assessing 66 drugs or drug combinations, antidepressants were the most evaluated (38 RCTs) but showed no effect on cocaine use or retention. Abstinence was significantly increased 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 was graded as low. Antipsychotics improved study retention with moderate strength of evidence (8 RCTs; RR 1.33, 95% CI 1.03 to 1.75).
Why it matters
Currently, no FDA-approved medications exist for cocaine use disorder; this review demonstrates that most investigated drugs are ineffective, though psychostimulants, bupropion, topiramate, and antipsychotics provide limited, specific benefits that warrant further exploration alongside behavioral interventions.
Limits
The strength of evidence supporting abstinence improvements for bupropion, topiramate, and psychostimulants was low, with several analyses based on only two RCTs. Overall participant counts, specific adverse events, and numerical outcomes for lapse or relapse were not reported in the abstract.
Cited by
- supports There are no pharmacotherapies with proven efficacy for treating crack cocaine or stimulant addiction.