Ling et al.'s 'Sustained-release methylphenidate in a randomized trial of treatment of methamphetamine use disorder'.
Ling et al.'s 'Sustained-release methylphenidate in a randomized trial of treatment of methamphetamine use disorder'.
复制标题
Ling 等人的“缓释哌甲酯用于治疗甲基苯丙胺使用障碍的随机试验”。
DOI：
10.1111/add.12885
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发表时间：
2015
期刊：
影响因子：
--
通讯作者：
Nunes,EdwardV
中科院分区：
文献类型：
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作者：
Levin,FrancesR;Mariani,JohnJ;Bisaga,Adam;Nunes,EdwardV
Ling等[1]评价哌甲酯缓释剂（MPH-SR）治疗甲基苯丙胺使用障碍的疗效。主要结果指标，在10周试验的最后30天内自我报告的甲基苯丙胺使用天数，在活性药物和安慰剂之间没有显著差异，尽管甲基苯丙胺使用的几个次要结果显示MPH-SR的有益效果。兴奋剂药物治疗兴奋剂使用障碍的前景并不乐观[2]。然而，我们认为研究中使用的MPH-SR剂量（54 mg/天）是适度的，可能还不足以产生最佳效果。现有证据支持更高剂量的兴奋剂对兴奋剂使用障碍的有效性。另一项研究发现，54 mg/天的MPH剂量对苯丙胺依赖患者有效[3]。较高剂量的MPH通常用于治疗注意缺陷多动障碍（ADHD），各种研究表明这是耐受性良好的[4-6]。值得注意的是，在一项研究中，当对苯丙胺依赖者给予更高剂量的MPH-SR（高达180 mg）时，MPH-SR在降低苯丙胺阳性尿液比例方面上级安慰剂[7]。当使用较低剂量时，同一研究组未观察到有益效果[5]。这与可卡因依赖患者的临床试验一致，在这些患者中，较高剂量的安非他明比较低剂量或安慰剂更可能引起可卡因戒断[8，9]。已发现足够的剂量对于其他激动剂替代策略治疗物质使用障碍的有效性至关重要，如美沙酮或丁丙诺啡维持。
Ling et al.[1] evaluated the efficacy of methylphenidate sustained-release (MPH-SR) as a treatment for methamphetamine use disorder. The primary outcome measure, self-reported days of methamphetamine use in the last 30 days of the 10-week trial, was not significantly different between active medication and placebo, although several of the secondary outcomes of methamphetamine use showed a beneficial effect of MPH-SR. The takeaway message might be that the results are equivocal, and stimulant medications are not so promising for treating stimulant use disorders [2]. However, we believe that the MPH-SR dose employed in the study, 54mg/day, was modest, and may not have been high enough to produce an optimal effect. The existing evidence supports the effectiveness of higher stimulant doses for stimulant use disorders.Another study found that an MPH dose of 54mg/day was effective among amphetaminedependent patients [3]. Higher doses of MPH are often used to treat attention deficit hyperactive disorder (ADHD), and various studies have shown this to be well tolerated [4–6]. Notably, in one study when a substantially higher dose of MPH-SR was administered (up to 180 mg) to amphetamine-dependent individuals, MPH-SR was superior to placebo in reducing the proportion of amphetamine-positive urines [7]. The same research group did not observe a beneficial effect when lower dosing was used [5]. This is consistent with clinical trials in cocaine-dependent patients in whom higher doses of amphetamine were more likely to elicit cocaine abstinence than lower doses or placebo [8, 9]. Adequate dosage has been found to be essential for effectiveness of other agonist-replacement strategies for substance use disorders, such as methadone or buprenorphine maintenance.