title: Dopamine agonists for the treatment of cocaine dependence.
abstract: BACKGROUND
  Cocaine misuse is a disorder for which no pharmacological treatment of proven efficacy exists. Advances in neurobiology could guide future medication development.
  
  
  OBJECTIVE
  To investigate the efficacy and acceptability of dopamine agonists alone or in combination with any psychosocial intervention for the treatment of of people who misuse cocaine.
  
  
  METHODS
  We run the search on 12 January 2015. We searched the Cochrane Drugs and Alcohol Group (CDAG) Specialized Register, PubMed, EMBASE, CINAHL, PsycINFO, ICTRP, clinicaltrials.gov and screened reference lists.
  
  
  METHODS
  Randomised controlled trials (RCTs) and controlled clinical trials (CCTs) comparing dopamine agonists alone or associated with psychosocial intervention with placebo, no treatment or other pharmacological interventions.
  
  
  METHODS
  We used standard Cochrane methodological procedures.
  
  
  RESULTS
  Twenty four studies, including 2147 participants, met the inclusion criteria. Comparing any dopamine agonist versus placebo, we found no differences for any of the outcomes considered: dropout (moderate quality of evidence), abstinence (low quality of evidence), severity of dependence (low quality of evidence), adverse events (moderate quality of evidence). This was also observed when single dopamine agonists were compared against placebo. Comparing amantadine versus antidepressants, we found low quality of evidence that antidepressants performed better for abstinence (RR 0.25, 95% CI 0.12 to 0.53) based on two studies with 44 participants. No differences were found for dropout or adverse events, for both moderate quality of evidence.The major flaws of the included studies concerned selection bias because most studies did not report information about sequence generation (80%) and allocation concealment methods (86%): half of the included studies were judged at unclear risk of performance bias and 62.5% at unclear risk of detection bias for what concerns subjective outcomes.
  
  
  CONCLUSIONS
  Current evidence from RCTs does not support the use of dopamine agonists for treating cocaine misuse. This absence of evidence may leave to clinicians the alternative of balancing the possible benefits against the potential adverse effects of the treatment. Even the potential benefit of combining a dopamine agonist with a more potent psychosocial intervention, which was suggested by the previous Cochrane Review (Soares 2003), is not supported by the results of this Cochrane Review update.
authors.affiliation: Department of Epidemiology, Lazio Regional Health Service, Via di Santa Costanza, 53, Rome, Italy, 00198.
authors.forename: Silvia
authors.initials: S
authors.lastname: Minozzi
authors.forename: Laura
authors.initials: L
authors.lastname: Amato
authors.forename: Pier Paolo
authors.initials: PP
authors.lastname: Pani
authors.forename: Renata
authors.initials: R
authors.lastname: Solimini
authors.forename: Simona
authors.initials: S
authors.lastname: Vecchi
authors.forename: Franco
authors.initials: F
authors.lastname: De Crescenzo
authors.forename: Piergiorgio
authors.initials: P
authors.lastname: Zuccaro
authors.forename: Marina
authors.initials: M
authors.lastname: Davoli
mesh_terms: D000547:Amantadine / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000627:therapeutic use; D001971:Bromocriptine / Q000627:therapeutic use; D019970:Cocaine-Related Disorders / Q000188:drug therapy*; D003863:Depression / Q000188:drug therapy; D018491:Dopamine Agonists / Q000627:therapeutic use*; D006801:Humans; D007980:Levodopa / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D015983:Selection Bias
chemical_list: D000928:Antidepressive Agents; D018491:Dopamine Agonists; D001971:Bromocriptine; D007980:Levodopa; D000547:Amantadine