Bupropion for treatment of amphetamine-type stimulant use disorder: A systematic review and meta-analysis of placebo-controlled randomized clinical trials

Affiliations

¹ Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada; Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada.
² Centre hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada.
³ University of British Columbia, Department of Medicine; British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada.
⁴ Department of Pharmacology and Toxicology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Center for Addiction and Mental Health, Toronto, Ontario, Canada; Waypoint Research Institute, Waypoint Centre for Mental Health Care, Penetanguishene, Ontario, Canada.
⁵ British Columbia Mental Health and Substance Use Services, Provincial Health Service Authority, University of British Columbia, Vancouver, Vancouver, British Columbia, Canada.
⁶ Translational Addictions Research Lab (TARL), Centre for Addiction and Mental Health, University of Toronto, Toronto, Canada; Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil.
⁷ St Vincent's Hospital Sydney Alcohol and Drug Service, Darlinghurst, Australia; The National Centre for Clinical Research on Emerging Drugs (NCCRED), The University of New South Wales (UNSW), Sydney, Australia; National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Randwick, Australia.
⁸ Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada; Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada. Electronic address: didier.jutras-aswad@umontreal.ca.

PMID: 37979478
DOI: 10.1016/j.drugalcdep.2023.111018

Meta-Analysis

Bupropion for treatment of amphetamine-type stimulant use disorder: A systematic review and meta-analysis of placebo-controlled randomized clinical trials

Hamzah Bakouni et al. Drug Alcohol Depend. 2023.

. 2023 Dec 1:253:111018.

doi: 10.1016/j.drugalcdep.2023.111018. Epub 2023 Nov 4.

Authors

Affiliations

¹ Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada; Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada.
² Centre hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada.
³ University of British Columbia, Department of Medicine; British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada.
⁴ Department of Pharmacology and Toxicology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Center for Addiction and Mental Health, Toronto, Ontario, Canada; Waypoint Research Institute, Waypoint Centre for Mental Health Care, Penetanguishene, Ontario, Canada.
⁵ British Columbia Mental Health and Substance Use Services, Provincial Health Service Authority, University of British Columbia, Vancouver, Vancouver, British Columbia, Canada.
⁶ Translational Addictions Research Lab (TARL), Centre for Addiction and Mental Health, University of Toronto, Toronto, Canada; Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil.
⁷ St Vincent's Hospital Sydney Alcohol and Drug Service, Darlinghurst, Australia; The National Centre for Clinical Research on Emerging Drugs (NCCRED), The University of New South Wales (UNSW), Sydney, Australia; National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Randwick, Australia.
⁸ Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada; Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada. Electronic address: didier.jutras-aswad@umontreal.ca.

PMID: 37979478
DOI: 10.1016/j.drugalcdep.2023.111018

Abstract

Background: This meta-analysis (PROSPERO-ID: CRD42022362962), pooled effect estimates of outcomes, from placebo-controlled randomized clinical trials (RCTs) examining bupropion efficacy and safety for amphetamine-type stimulant use disorder (ATSUD) treatment.

Method: Electronic databases were searched for records published to October 31st, 2022, including MEDLINE, CINAHL, PsycINFO, EBM Reviews, EMBASE, PubMed, Web of Science, trial registries. Inclusion criteria were RCTs comparing bupropion to placebo in ATSUD. Cochrane RoB2 tool and GRADE evidence certainty assessment were employed. Outcomes included amphetamine-type stimulant (ATS) use by urinalysis, retention in treatment, treatment adherence, ATS craving, addiction severity, depressive symptom severity, drop-out following adverse events (AEs), and serious AEs. Random-effect meta-analysis was conducted presenting standardized mean difference (SMD), risk ratio (RR), and risk difference (RD).

Results: Eight RCTs (total N=1239 participants) were included. Bupropion compared to placebo was associated with reduced ATS use (RR: 0.90; 95% CI: 0.84, 0.96), end-of-treatment ATS craving (SMD: -0.38; 95%CI: -0.63, -0.13), and adherence (RR: 0.91; 95%CI: 0.84, 0.99). Subgroup analysis showed greater reduction in ATS use with longer trial duration (12 weeks) (RR: 0.85; 95%CI: 0.78, 0.93) and greater reduction in end-of-treatment ATS craving in studies with mixed ATS use frequency (SMD: -0.46; 95%CI: -0.70, -0.22) and male-only samples (SMD: -1.26; 95%CI: -1.87, -0.65).

Conclusion: Bupropion showed a significant modest reduction in ATS use and ATS craving (both rated as very low-quality evidence), larger in males (craving), and with longer treatment (ATS use). These results may inform future studies. More research is warranted on who might benefit from bupropion as ATSUD treatment.

Keywords: Amphetamine; Amphetamine use disorder; Bupropion; Meta-analysis; Methamphetamine; Pharmacotherapy; Treatment.

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Conflict of interest statement

Declaration of Competing Interest PB is the site PI for upcoming trial on psychostimulants for the treatment of methamphetamine use disorder. CGS is a consultant at Clearmind Medicine. NE has received funding from the Australian National Health and Medical Research Council (NHMRC) to conduct a study examining lisdexamfetamine for the treatment of MAUD (APP1109466). KS has received funding from the National Centre for Clinical Research on Emerging Drugs (NCCRED) to conduct a pilot study of lisdexamfetamine for methamphetamine withdrawal (NCCRED is funded by the Australian Government Department of Health [4-EH8ULD4]). BLF has obtained funding from Pfizer Inc. (GRAND Awards, including salary support) for investigator-initiated projects. BLF has obtained funding from Indivior for a clinical trial sponsored by Indivior. BLF has in-kind donations of cannabis products from Aurora Cannabis Enterprises Inc. and study medication donations from Pfizer Inc. (varenicline for smoking cessation) and Bioprojet Pharma. BLF was also provided a coil for a Transcranial magnetic stimulation (TMS) study from Brainsway. BLF has obtained industry funding from Canopy Growth Corporation (through research grants handled by the Centre for Addiction and Mental Health and the University of Toronto), Bioprojet Pharma, Alcohol Countermeasure Systems (ACS), Alkermes, and Universal Ibogaine. BLF has participated in a session of a National Advisory Board Meeting (Emerging Trends BUP-XR) for Indivior Canada and has been a consultant for Shinogi. DJA receives study material from Cardiol Therapeutics and Exka for clinical trials funded by the Quebec Ministry of Health and Social Services. All other authors declare no conflict of interest.

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Bupropion for treatment of amphetamine-type stimulant use disorder: A systematic review and meta-analysis of placebo-controlled randomized clinical trials

Affiliations

Bupropion for treatment of amphetamine-type stimulant use disorder: A systematic review and meta-analysis of placebo-controlled randomized clinical trials

Authors

Affiliations

Abstract

Conflict of interest statement

References

Publication types

MeSH terms

Substances

LinkOut - more resources

Full Text Sources

Medical

Miscellaneous