Ling Walter, Chang Linda, Hillhouse Maureen, Ang Alfonso, Striebel Joan, Jenkins Jessica, Hernandez Jasmin, Olaer Mary, Mooney Larissa, Reed Susan, Fukaya Erin, Kogachi Shannon, Alicata Daniel, Holmes Nataliya, Esagoff Asher
Integrated Substance Abuse Programs, University of California, Los Angeles, Los Angeles, CA, USA.
Addiction. 2014 Sep;109(9):1489-500. doi: 10.1111/add.12608. Epub 2014 Jul 8.
No effective pharmacotherapy for methamphetamine (MA) use disorder has yet been found. This study evaluated sustained-release methylphenidate (MPH-SR) compared with placebo (PLA) for treatment of MA use disorder in people also undergoing behavioral support and motivational incentives.
This was a randomized, double-blind, placebo-controlled design with MPH-SR or PLA provided for 10 weeks (active phase) followed by 4 weeks of single-blind PLA. Twice-weekly clinic visits, weekly group counseling (CBT) and motivational incentives (MI) for MA-negative urine drug screens (UDS) were included.
Treatment sites were in Los Angeles, California (LA) and Honolulu, Hawaii (HH), USA.
A total of 110 MA-dependent (via DSM-IV) participants (LA = 90; HH = 20).
The primary outcome measure is self-reported days of MA use during the last 30 days of the active phase. Included in the current analyses are drug use (UDS and self-report), retention, craving, compliance (dosing, CBT, MI), adverse events and treatment satisfaction.
No difference was found between treatment groups in self-reported days of MA use during the last 30 days of the active phase (P = 0.22). In planned secondary outcomes analyses, however, the MPH group had fewer self-reported MA use days from baseline through the active phase compared with the PLA group (P = 0.05). The MPH group also had lower craving scores and fewer marijuana-positive UDS than the PLA group in the last 30 days of the active phase. The two groups had similar retention, other drug use, adverse events and treatment satisfaction.
Methylphenidate may lead to a reduction in concurrent methamphetamine use when provided as treatment for patients undergoing behavioral support for moderate to severe methamphetamine use disorder, but this requires confirmation.
尚未找到治疗甲基苯丙胺（MA）使用障碍的有效药物疗法。本研究评估了缓释哌醋甲酯（MPH-SR）与安慰剂（PLA）相比，在接受行为支持和动机激励的人群中治疗MA使用障碍的效果。
这是一项随机、双盲、安慰剂对照设计，提供MPH-SR或PLA治疗10周（活跃期），随后是4周的单盲PLA治疗。包括每周两次门诊就诊、每周一次针对MA阴性尿液药物筛查（UDS）的团体咨询（CBT）和动机激励（MI）。
治疗地点位于美国加利福尼亚州洛杉矶（LA）和夏威夷檀香山（HH）。
共有110名依赖MA（根据《精神疾病诊断与统计手册第四版》[DSM-IV]）的参与者（LA = 9名；HH = 20名）。
主要结局指标是活跃期最后30天内自我报告的MA使用天数。当前分析包括药物使用（UDS和自我报告）、留存率、渴望程度、依从性（给药、CBT、MI）、不良事件和治疗满意度。
在活跃期最后30天内，治疗组之间自我报告的MA使用天数无差异（P = 0.22）。然而，在计划的次要结局分析中，与PLA组相比，MPH组从基线到活跃期自我报告的MA使用天数更少（P = 0.05）。在活跃期的最后30天，MPH组的渴望程度得分也低于PLA组，且MA阳性UDS更少。两组在留存率、其他药物使用、不良事件和治疗满意度方面相似。
当作为对中度至重度甲基苯丙胺使用障碍接受行为支持的患者的治疗方法时，哌醋甲酯可能会减少同时使用甲基苯丙胺的情况，但这需要进一步证实。
