Unit of Human Pharmacology and Neurosciences, Institut de Recerca de l'Hospital del Mar, IMIM-Parc de Salut Mar, Barcelona, Spain.
J Subst Abuse Treat. 2011 Mar;40(2):109-22. doi: 10.1016/j.jsat.2010.08.012. Epub 2010 Oct 30.
Psychostimulant dependence is characterized by dopamine deficit, which could be reversed with indirect dopamine agonists (IDAs). A systematic review and meta-analysis of randomized, parallel-group, placebo-controlled clinical trials assessing the efficacy of IDAs in psychostimulant-dependent individuals were conducted. The study outcomes were psychostimulant abstinence, assessed by means of urinalysis, and retention in treatment. Risk of bias was determined using a Cochrane Collaboration instrument. Twenty-nine studies fulfilled the inclusion criteria, involving 2,467 participants. Compared with placebo, IDAs increased psychostimulant abstinence (standardized mean difference = 0.20; 95% confidence interval, 0.06-0.35; p = .005) but did not increase retention in treatment. Efficacy was larger in comorbid heroin-dependent individuals and was positively related with treatment length. No study was considered fully free of bias. IDAs appear to be efficacious for reducing psychostimulant use but did not improve retention. Efforts should be undertaken to reduce the risk of bias of clinical trials with psychostimulant-dependent individuals.
精神兴奋剂依赖的特征是多巴胺缺乏，这可以通过间接多巴胺激动剂（IDAs）来逆转。对评估 IDAs 在精神兴奋剂依赖个体中的疗效的随机、平行组、安慰剂对照临床试验进行了系统评价和荟萃分析。研究结果是通过尿液分析评估的精神兴奋剂戒断，以及治疗的保留率。使用 Cochrane 合作工具确定偏倚风险。29 项研究符合纳入标准，涉及 2467 名参与者。与安慰剂相比，IDAs 增加了精神兴奋剂戒断（标准化均数差=0.20；95%置信区间，0.06-0.35；p=0.005），但并未增加治疗保留率。在合并海洛因依赖的个体中，疗效更大，并且与治疗时间呈正相关。没有一项研究被认为完全没有偏倚。IDAs 似乎对减少精神兴奋剂的使用有效，但不能提高保留率。应该努力降低有精神兴奋剂依赖个体的临床试验的偏倚风险。
