Farkouh Rezkalla, Audette-Chapdelaine Sophie, Brodeur Magaly
Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada.
Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada.
J Addict Dis. 2024 Oct-Dec;42(4):274-288. doi: 10.1080/10550887.2023.2229725. Epub 2023 Jul 9.
Gambling disorder (GD) is a psychiatric disorder classified in the DSM-5 as a non-substance-related and addictive disorder with extensive health and socioeconomic impacts. Its chronic and high-relapsing nature makes it essential to find treatment strategies that improve functioning and reduce impairment associated with it. The purpose of this narrative review is to evaluate and summarize the available evidence on the effectiveness and safety of pharmacotherapy in GD.
An electronic literature search of Medline, Embase, and Cochrane Central was conducted to identify systematic reviews, meta-analyses, and reviews on pharmacological interventions in patients with gambling disorder. A similar search of these databases and of Prospero, Clinicaltrials.gov, and Epistemonikos was conducted to identify clinical trials that were published since 2019.
The initial search identified 1925 articles. After screening and duplicate removal, 18 articles were included in the review (11 studies were systematic reviews and meta-analyses, 6 were reviews, and 1 was an open-label trial). Eight pharmacological agents (naltrexone, nalmefene, paroxetine, fluvoxamine, citalopram, escitalopram, lithium, and topiramate that were studied in randomized controlled trials and open-label trials showed small to moderate effect sizes in reducing GD symptoms in some studies during post-hoc analyses.
The overall sum of evidence in the literature on the use of pharmacotherapy in GD is conflicting and inconclusive. Some studies have shown that pharmacotherapy's role in GD is promising, especially when the choice of the agent is guided by comorbid psychiatric disorders. However, significant limitations exist in the study designs, which need to be addressed in future research on the topic. Conducting future and more rigorous trials that address the limitations in the existing literature is necessary to establish more accurate efficacy data on the use of pharmacotherapy in this population.
赌博障碍（GD）是一种精神障碍，在《精神疾病诊断与统计手册》第5版（DSM - 5）中被归类为与物质无关的成瘾性障碍，具有广泛的健康和社会经济影响。其慢性和高复发的性质使得找到改善功能并减少与之相关损害的治疗策略至关重要。本叙述性综述的目的是评估和总结药物治疗在GD中的有效性和安全性的现有证据。
对Medline、Embase和Cochrane中心进行电子文献检索，以识别关于赌博障碍患者药物干预的系统评价、荟萃分析和综述。对这些数据库以及Prospero、Clinicaltrials.gov和Epistemonikos进行类似检索，以识别自2019年以来发表的临床试验。
初步检索识别出1925篇文章。经过筛选和去除重复项后，18篇文章纳入综述（11项研究为系统评价和荟萃分析，6项为综述，1项为开放标签试验）。在随机对照试验和开放标签试验中研究的8种药物（纳曲酮、纳美芬、帕罗西汀、氟伏沙明、西酞普兰、艾司西酞普兰、锂盐和托吡酯）在事后分析的一些研究中显示出在减轻GD症状方面有小到中等程度的效应量。
关于药物治疗在GD中应用的文献总体证据相互矛盾且无定论。一些研究表明，药物治疗在GD中的作用很有前景，特别是当药物选择以共病精神障碍为指导时。然而，研究设计存在重大局限性，这需要在该主题的未来研究中加以解决。进行未来更严格的试验以解决现有文献中的局限性对于建立关于该人群药物治疗使用的更准确疗效数据是必要的。
