title: A retrospective analysis of two randomized trials of bupropion for methamphetamine dependence: suggested guidelines for treatment discontinuation/augmentation.
abstract: BACKGROUND
  Two clinical trials have shown efficacy for bupropion in treating methamphetamine (MA) dependence among those with moderate baseline MA use. However, treatment response is highly variable and it is unclear what duration of treatment is necessary to determine if maintaining the treatment course is indicated or if discontinuation or augmentation is appropriate. The present study assessed the relationship among early bupropion treatment response for moderate MA users and end-of-treatment (EOT) abstinence. These data provide estimates of the duration of treatment and the degree of responsiveness required to persist in bupropion treatment.
  
  
  METHODS
  Participants with moderate baseline MA use in the bupropion condition of two randomized double-blind placebo controlled trials were included. The relationship between early treatment response and EOT outcomes was assessed with Receiver Operating Characteristic (ROC) curves.
  
  
  RESULTS
  With thrice weekly urine drug testing, excellent predictive power was established in the first two weeks of treatment. The inability to achieve at least three MA negative samples in the first two weeks is associated with greater than 90% likelihood of treatment failure. More closely approximating clinical settings, once-weekly testing featured reliable predictive power within three weeks, suggesting that the failure to produce at least two clean samples in the first three weekly visits confers high risk of treatment failure.
  
  
  CONCLUSIONS
  The findings provide preliminary evidence to guide clinical decisions for moderate MA users receiving bupropion. The results are consistent with data from the smoking cessation literature and may highlight the importance of early response in addiction treatment.
authors.affiliation: Department of Family Medicine, David Geffen School of Medicine at UCLA, CA 90095, USA. mbrensilver@mednet.ucla.edu
authors.forename: Matthew
authors.initials: M
authors.lastname: Brensilver
authors.forename: Keith G
authors.initials: KG
authors.lastname: Heinzerling
authors.forename: Aimee-Noelle
authors.initials: AN
authors.lastname: Swanson
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Shoptaw
mesh_terms: D000328:Adult; D019969:Amphetamine-Related Disorders / Q000188:drug therapy*; D016642:Bupropion / Q000627:therapeutic use*; D018765:Dopamine Uptake Inhibitors / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D017408:Guidelines as Topic; D006801:Humans; D008297:Male; D008694:Methamphetamine / Q000652:urine; D012372:ROC Curve; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D015813:Substance Abuse Detection; D016896:Treatment Outcome
chemical_list: D018765:Dopamine Uptake Inhibitors; D016642:Bupropion; D008694:Methamphetamine