Kovanen Leena, Basnet Syaron, Castrén Sari, Pankakoski Maiju, Saarikoski Sirkku T, Partonen Timo, Alho Hannu, Lahti Tuuli
Mental Health Unit, National Institute for Health and Welfare, Department of Health, Helsinki, Finland.
Eur Addict Res. 2016;22(2):70-9. doi: 10.1159/000435876. Epub 2015 Sep 5.
BACKGROUND/AIMS: Effective treatment strategies are needed for the treatment of pathological gambling (PG). The efficacy of as-needed naltrexone was assessed in a single-centre, randomised, double-blind, placebo-controlled trial.
The participants (n = 101) received either as-needed placebo or naltrexone (50 mg) and psychosocial support for 20 weeks. The primary outcome measure was the severity of PG assessed by the Yale-Brown Obsessive Compulsive Scale adapted for PG (PG-YBOCS). Secondary gambling-related outcome measures included thoughts/urges and behaviour subscales of PG-YBOCS as well as the highest daily expenditure and gambling frequency. In addition, RAND-36 scales of emotional well-being and social functioning were used as outcomes. The results were analysed using the intention-to-treat principle and linear random effects modelling.
No significant treatment group differences were found. In an exploratory analysis, emotional well-being increased in a subgroup of participants with AA genotype of opioid receptor, mu 1 (OPRM1) A118G polymorphism (p = 0.02).
Overall, the as-needed naltrexone may not provide substantial additional benefit for PG patients receiving psychosocial support. Replication by larger scale studies is warranted to further evaluate naltrexone administration schedules for the treatment of PG and the role of OPRM1.
背景/目的：病理性赌博（PG）的治疗需要有效的治疗策略。在一项单中心、随机、双盲、安慰剂对照试验中评估了按需使用纳曲酮的疗效。
参与者（n = 101）接受按需使用的安慰剂或纳曲酮（50毫克）以及心理社会支持，为期20周。主要结局指标是通过适用于PG的耶鲁-布朗强迫量表（PG-YBOCS）评估的PG严重程度。与赌博相关的次要结局指标包括PG-YBOCS的思维/冲动和行为子量表，以及每日最高支出和赌博频率。此外，使用RAND-36情感幸福感和社会功能量表作为结局指标。结果采用意向性分析原则和线性随机效应模型进行分析。
未发现治疗组之间存在显著差异。在一项探索性分析中，阿片受体μ1（OPRM1）A118G基因多态性AA基因型的参与者亚组中，情感幸福感有所增加（p = 0.02）。
总体而言，按需使用纳曲酮可能不会为接受心理社会支持的PG患者带来实质性的额外益处。有必要通过更大规模的研究进行重复验证，以进一步评估纳曲酮治疗PG的给药方案以及OPRM1的作用。
