Pharmacology Department, Nantes University Hospital, Nantes, France.
INSERM UMR1246 SPHERE Methods in Patients-centered outcomes and Health Research, University of Nantes and Tours, Nantes, France.
Curr Neuropharmacol. 2018;16(10):1418-1432. doi: 10.2174/1570159X15666170718144058.
To date, no drugs have been approved for gambling disorder. Numerous publications have described the value of opioid antagonists. Indeed, the mesocorticolimbic dopaminergic pathway has been suggested as the underlying cause of reward-seeking behaviour, and it is modulated by the opioid system.
This study aims to evaluate the relevance of opioid antagonists for treating GD.
A systematic literature review was conducted. A search of the PubMed electronic database, PsycINFO and the Cochrane Systematic Review Database without any limits was performed.
There is little information concerning the effects of opioid antagonists on GD. The total search with "nalmefene and gambling" without any limits revealed only 11 articles. The search with "naltrexone and gambling" without any limits generated 47 articles. Nevertheless, the best available data support the use of opioid antagonists, particularly in individuals with a history of alcohol use disorder or strong gambling urges.
Future trials are still needed. Indeed, opioid antagonists effectiveness has been investigated in only a limited number of patients, clinical trials do not reflect the heterogeneity of GD and there is little knowledge of the predictive factors of response to treatments. Moreover, differential affinity to nalmefene for kappa receptors may be associated with a particular effect in a yet to be defined addiction phenotype. Head to head comparisons between naltrexone and nalmefene would be helpful in combining other medication or psychotherapy. The identification of subgroups of patients that are more likely to benefit from opioid antagonists should be a goal.
迄今为止，尚无药物被批准用于治疗赌博障碍。大量出版物已经描述了阿片类拮抗剂的价值。事实上，中脑边缘多巴胺能通路被认为是寻求奖励行为的潜在原因，并且它受阿片系统的调节。
本研究旨在评估阿片类拮抗剂治疗 GD 的相关性。
进行了系统的文献回顾。对 PubMed 电子数据库、PsycINFO 和 Cochrane 系统评价数据库进行了无限制的搜索。
关于阿片类拮抗剂对 GD 的影响的信息很少。总搜索“nalmefene 和赌博”无限制仅显示了 11 篇文章。搜索“naltrexone 和赌博”无限制生成了 47 篇文章。然而，最好的现有数据支持使用阿片类拮抗剂，特别是在有酒精使用障碍或强烈赌博冲动史的个体中。
仍需要进一步的试验。实际上，阿片类拮抗剂的有效性仅在有限数量的患者中进行了研究，临床试验不能反映 GD 的异质性，并且对治疗反应的预测因素知之甚少。此外，κ 受体对纳美芬的不同亲和力可能与尚未定义的成瘾表型中的特定作用相关。纳曲酮和纳美芬之间的头对头比较将有助于结合其他药物或心理治疗。确定更有可能从阿片类拮抗剂中受益的患者亚组应是一个目标。
