Management of Amphetamine and Methamphetamine Use Disorders: A Systematic Review and Network Meta-analysis of...

Area of Science:

• Pharmacology and Addiction Medicine
• Clinical Psychology
• Public Health Interventions

Background:

• Effective management strategies for methamphetamine and amphetamine (MA/A) use disorders remain inconclusive.
• A comprehensive assessment of available interventions is crucial for guiding clinical practice.

Purpose of the Study:

• To compare the benefits and tolerability of pharmacological, psychosocial, and harm reduction interventions for MA/A use disorders.
• To synthesize evidence from randomized controlled trials using network meta-analysis.

Main Methods:

• Systematic search of six electronic databases for relevant randomized controlled trials.
• Random-effects frequentist network meta-analysis and GRADE assessment of evidence certainty.
• Inclusion of 72 trials with 6836 adult participants diagnosed with MA/A use disorders.

Main Results:

• Low-certainty evidence suggests quetiapine may improve abstinence and reduce drug use.
• Riluzole and methylphenidate showed potential benefits in reducing drug use, with very low to low certainty.
• Contingency management demonstrated potential for longer abstinence durations (very low certainty).
• Venlafaxine and citicoline were identified as potentially tolerable interventions (low certainty).

Conclusions:

• While some interventions show slight improvements in specific outcomes for MA/A use disorders, no intervention demonstrated moderate- to high-certainty evidence for significant patient-important benefits.
• Further high-quality research is needed to establish definitive treatment efficacy.