Bupropion for treatment of amphetamine-type stimulant use disorder: A systematic review and meta-analysis of placebo-controlled randomized clinical trials

Hamzah Bakouni; Heidar Sharafi; Arash Bahremand; Sarah Drouin; Daniela Ziegler; Paxton Bach; Bernard Le Foll; Christian G Schütz; Vitor Tardelli; Nadine Ezard; Krista Siefried; Didier Jutras-Aswad

doi:10.1016/j.drugalcdep.2023.111018

Bupropion for treatment of amphetamine-type stimulant use disorder: A systematic review and meta-analysis of placebo-controlled randomized clinical trials

Drug Alcohol Depend. 2023 Dec 1:253:111018. doi: 10.1016/j.drugalcdep.2023.111018. Epub 2023 Nov 4.

Authors

Affiliations

¹ Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada; Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada.
² Centre hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada.
³ University of British Columbia, Department of Medicine; British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada.
⁴ Department of Pharmacology and Toxicology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Center for Addiction and Mental Health, Toronto, Ontario, Canada; Waypoint Research Institute, Waypoint Centre for Mental Health Care, Penetanguishene, Ontario, Canada.
⁵ British Columbia Mental Health and Substance Use Services, Provincial Health Service Authority, University of British Columbia, Vancouver, Vancouver, British Columbia, Canada.
⁶ Translational Addictions Research Lab (TARL), Centre for Addiction and Mental Health, University of Toronto, Toronto, Canada; Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil.
⁷ St Vincent's Hospital Sydney Alcohol and Drug Service, Darlinghurst, Australia; The National Centre for Clinical Research on Emerging Drugs (NCCRED), The University of New South Wales (UNSW), Sydney, Australia; National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Randwick, Australia.
⁸ Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada; Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada. Electronic address: didier.jutras-aswad@umontreal.ca.

PMID: 37979478
DOI: 10.1016/j.drugalcdep.2023.111018

Abstract

Background: This meta-analysis (PROSPERO-ID: CRD42022362962), pooled effect estimates of outcomes, from placebo-controlled randomized clinical trials (RCTs) examining bupropion efficacy and safety for amphetamine-type stimulant use disorder (ATSUD) treatment.

Method: Electronic databases were searched for records published to October 31st, 2022, including MEDLINE, CINAHL, PsycINFO, EBM Reviews, EMBASE, PubMed, Web of Science, trial registries. Inclusion criteria were RCTs comparing bupropion to placebo in ATSUD. Cochrane RoB2 tool and GRADE evidence certainty assessment were employed. Outcomes included amphetamine-type stimulant (ATS) use by urinalysis, retention in treatment, treatment adherence, ATS craving, addiction severity, depressive symptom severity, drop-out following adverse events (AEs), and serious AEs. Random-effect meta-analysis was conducted presenting standardized mean difference (SMD), risk ratio (RR), and risk difference (RD).

Results: Eight RCTs (total N=1239 participants) were included. Bupropion compared to placebo was associated with reduced ATS use (RR: 0.90; 95% CI: 0.84, 0.96), end-of-treatment ATS craving (SMD: -0.38; 95%CI: -0.63, -0.13), and adherence (RR: 0.91; 95%CI: 0.84, 0.99). Subgroup analysis showed greater reduction in ATS use with longer trial duration (12 weeks) (RR: 0.85; 95%CI: 0.78, 0.93) and greater reduction in end-of-treatment ATS craving in studies with mixed ATS use frequency (SMD: -0.46; 95%CI: -0.70, -0.22) and male-only samples (SMD: -1.26; 95%CI: -1.87, -0.65).

Conclusion: Bupropion showed a significant modest reduction in ATS use and ATS craving (both rated as very low-quality evidence), larger in males (craving), and with longer treatment (ATS use). These results may inform future studies. More research is warranted on who might benefit from bupropion as ATSUD treatment.

Keywords: Amphetamine; Amphetamine use disorder; Bupropion; Meta-analysis; Methamphetamine; Pharmacotherapy; Treatment.

Publication types

Meta-Analysis
Systematic Review
Review

MeSH terms

Amphetamines / therapeutic use
Bupropion* / adverse effects
Humans
Male
Randomized Controlled Trials as Topic
Substance-Related Disorders* / drug therapy

Substances

Bupropion
Amphetamines