Pharmacotherapeutic strategies for treating cocaine use disorder-what do we have to offer?
Pharmacotherapeutic strategies for treating cocaine use disorder-what do we have to offer?
复制标题
DOI：
10.1111/add.15242
复制
发表时间：
2021-04
期刊：
影响因子：
--
通讯作者：
Levin FR
中科院分区：
文献类型：
--
作者：
Brandt L;Chao T;Comer SD;Levin FR
可卡因的使用仍然是世界范围内一个重大的公共卫生问题。然而，尽管大量的研究努力，没有药物疗法被批准用于治疗可卡因使用障碍（CUD）。研究已经确定了一系列治疗反刍疾病的药物的积极信号。这些药物包括长效安非他明制剂、莫达非尼、托吡酯、多沙唑嗪以及托吡酯和混合安非他明盐缓释制剂（MAS-ER）。然而，关于药物临床疗效的有效结论需要细致入微的方法，考虑到目标人群的行为表型（使用频率、可卡因和其他物质的共同滥用、遗传亚群、精神共病）、与药物相关的变量（剂量、短效/长效制剂、滴定速度、药物依从性）和其他可能影响治疗结果的因素。荟萃分析经常没有考虑到这些共同变化的因素，这导致了对CUD药物治疗选择的一些虚无主义观点。此外，主要关注禁欲，这对大多数患者来说很难实现，可能掩盖了更微妙的治疗信号。虽然强调寻找具有新的作用机制的治疗CUD的新药物，但现有的药物值得在现有文献的基础上进一步研究。在明确定义的患者亚组中评估治疗成功的精确指标，并进一步探索联合治疗及其与行为/社会心理干预的协同作用，是建立有效治疗CUD的有希望的途径。
Cocaine use contines to be a significant public health problem world-wide. However, despite substantial research efforts, no pharmacotherapies are approved for the treatment of cocaine use disorder (CUD). Studies have identified positive signals for a range of medications for treating CUD. These include long-acting amphetamine formulations, modafinil, topiramate, doxazosin and combined topiramate and mixed amphetamine salts extended-release (MAS-ER). However, valid conclusions about a medication’s clinical efficacy require nuanced approaches that take into account behavioural phenotypes of the target population (frequency of use, co-abuse of cocaine and other substances, genetic subgroups, psychiatric comorbidity), variables related to the medication (dose, short-/long-acting formulations, titration speed, medication adherence) and other factors that may affect treatment outcomes. Meta-analyses frequently do not account for these co-varying factors, which contributes to a somewhat nihilistic view on pharmacotherapeutic options for CUD. In addition, the predominant focus on abstinence, which is difficult for most patients to achieve, may overshadow more nuanced therapeutic signals. While there is an emphasis on finding new medications with novel mechanisms of action for treating CUD, currently available medications deserve further investigation based on the existing literature. Evaluating refined metrics of treatment success in well-defined subgroups of patients, and further exploring combination therapies and their synergy with behavioural/psychosocial interventions, are promising avenues to establishing effective therapies for CUD.
登录
查看更多内容
与奖励相关行为中的多巴胺信号传导。
影响因子：
3.5
作者：
Baik JH
通讯作者：
Baik JH
影响因子：
4.2
作者：
Comer, S. D.;Ashworth, J. B.;Walsh, S. L.
通讯作者：
Walsh, S. L.
影响因子：
--
作者：
Carroll, KM;Fenton, LR;Rounsaville, BJ
通讯作者：
Rounsaville, BJ
影响因子：
2.9
作者：
Beresford, Thomas;Buchanan, Jennifer;Ronan, Patrick J.
通讯作者：
Ronan, Patrick J.
影响因子：
3.4
作者：
BLANC, G;TROVERO, F;TASSIN, JP
通讯作者：
TASSIN, JP