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Agonisti dopamina za liječenje ovisnosti o kokainu

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Abstract

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Background

Cocaine dependence is a disorder for which no pharmacological treatment of proven efficacy exists, advances in the 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 cocaine abuse and dependence

Search methods

We searched the Cochrane Drugs and Alcohol Group (CDAG) Specialized Register, PubMed, EMBASE and CINAHL, PsycINFO in June 2011 and researchers for unpublished trials

Selection criteria

Randomised and controlled clinical trials comparing dopamine agonists alone or associated with psychosocial intervention with placebo, no treatment, other pharmacological interventions

Data collection and analysis

Two authors independently assessed trial quality and extracted data

Main results

Twenty three studies, 2066 participants, met the inclusion criteria. Comparing any dopamine agonist versus placebo, placebo performed better for severity of dependence, four studies, 232 participants, SMD 0.43 (95% CI 0.15 to 0.71), depression, five studies, 322 participants, SMD 0.42 (95% CI 0.19 to 0.65) and abstinent at follow up RR 0.57 (95% CI 0.35 to 0.93). No statistically significant different for the other outcomes considered. Comparing amantadine versus placebo, results never gain the statistical significance, but there is a trend in favour of amantadine for dropouts and depression. Results on adverse events and depression, were in favour of placebo although the difference do not reach the statistical significance. Comparing bromocriptine and Ldopa/Carbidopa versus placebo, results never reached statistical significance. Comparing amantadine versus antidepressants, antidepressants performed better for abstinence. The other two outcomes considered did not show statistically significant differences although dropouts and adverse events tended to be more common in the antidepressant group.

The quality of evidence, assessed according to GRADE method, may be judged as moderate for the efficacy of any dopamine agonist versus placebo and as moderate to high for amantadine versus placebo and versus antidepressants.

Authors' conclusions

Current evidence from randomised controlled trials does not support the use of dopamine agonists for treating cocaine dependence. 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 updated review.

PICO

Population
Intervention
Comparison
Outcome

El uso y la enseñanza del modelo PICO están muy extendidos en el ámbito de la atención sanitaria basada en la evidencia para formular preguntas y estrategias de búsqueda y para caracterizar estudios o metanálisis clínicos. PICO son las siglas en inglés de cuatro posibles componentes de una pregunta de investigación: paciente, población o problema; intervención; comparación; desenlace (outcome).

Para saber más sobre el uso del modelo PICO, puede consultar el Manual Cochrane.

Plain language summary

Agonisti dopamina za liječenje ovisnosti o kokainu

Za liječenje ovisnosti o kokainu ne postoji farmakološka tvar s dokazanom djelotvornosti. Kokain je alkaloid dobiven iz lista erythroxylon koke koji se koristi kao prah za intranazalnu (putem nosa) ili intravensku (putem vene) primjenu, ili kao krek (engl. crack) u obliku slobodne baze koji se puši. Ovisnost o kokainu je veliki javnozdravstveni problem jer njegova primjena može biti povezana s medicinskim i psihosocijalnim komplikacijama, uključujući širenje zaraznih bolesti (poput AIDS‐a, hepatitisa i tuberkuloze), kriminalom, nasiljem i neonatalnom izloženosti drogi. Ovaj Cochrane sustavni pregled je pretražio dokaze o djelotvornosti i prihvatljivosti agonista dopamina u liječenju ovisnosti, samih ili u kombinaciji s nekom od psihosocijalnih intervencija.