title: Efficacy and safety of psychostimulants for amphetamine and methamphetamine use disorders: a systematic review and meta-analysis.
abstract: Amphetamine and methamphetamine use disorders are associated with severe health and social consequences. No pharmacological therapy has been approved for the treatment of these disorders. Psychostimulants can act as maintenance-like therapies for managing substance use among these patients. The aim of this study is to evaluate the literature examining the efficacy and safety of psychostimulant agents for increasing abstinence and treatment retention among patients with amphetamine and methamphetamine use disorders.
  
  
  
  We searched MEDLINE, EMBASE, PsycInfo, Cochrane Central, and CINAHL from inception to August 2016. Selection of studies, data extraction, and risk of bias assessment were conducted independently by two reviewers. We conducted meta-analyses to provide a pooled summary estimate for included trials and report the review according to PRISMA guidelines.
  
  
  
  We identified and selected 17 studies with 1387 participants. Outcome reporting across trials was inconsistent, and the overall quality of evidence was very low due to high risk of bias and indirectness. A meta-analysis of five trials (642 participants) found no effect of psychostimulants for end-of-study abstinence (odds ratio = 0.97, 95% confidence interval 0.65 to 1.45). Additionally, the pooled estimate from 14 studies (1184 participants) showed no effect of psychostimulants for treatment retention (odds ratio = 1.20, 95% confidence interval = 0.91 to 1.58). The incidence of serious adverse events did not differ between intervention and placebo groups based on qualitative reports from trials.
  
  
  
  Quantitative analyses showed no effect of psychostimulants for sustained abstinence or treatment retention. We also identified the need for more rigorous studies in this research area with clinician and patient important outcomes.
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main Street W., Hamilton, ON, L8S 4L8, Canada.
authors.forename: Meha
authors.initials: M
authors.lastname: Bhatt
authors.affiliation: MiNDS Neuroscience Graduate Program, McMaster University, 1280 Main Street W., Hamilton, ON, L8S 4L8, Canada.
authors.forename: Laura
authors.initials: L
authors.lastname: Zielinski
authors.affiliation: St. George's University of London, Cranmer Terrace, London, SW17 0RE, UK.
authors.forename: Lola
authors.initials: L
authors.lastname: Baker-Beal
authors.affiliation: Health Sciences Library, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada.
authors.forename: Neera
authors.initials: N
authors.lastname: Bhatnagar
authors.affiliation: Juravinski Hospital, Hamilton Health Sciences, 711 Concession Street, Hamilton, ON, L8V 1C3, Canada.
authors.forename: Natalia
authors.initials: N
authors.lastname: Mouravska
authors.affiliation: St. Joseph's Healthcare Hamilton, 100 West 5th Street, Hamilton, ON, L8N 3K7, Canada.
authors.forename: Phillip
authors.initials: P
authors.lastname: Laplante
authors.affiliation: Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada.
authors.forename: Andrew
authors.initials: A
authors.lastname: Worster
authors.affiliation: Biostatistics Unit, Centre for Evaluation of Medicine, 25 Main Street West Suite 2000, Hamilton, ON, L8P 1H1, Canada.|System-Linked Research Unit on Health and Social Service Utilization, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada.
authors.forename: Lehana
authors.initials: L
authors.lastname: Thabane
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main Street W., Hamilton, ON, L8S 4L8, Canada. samaanz@mcmaster.ca.|St. Joseph's Healthcare Hamilton, 100 West 5th Street, Hamilton, ON, L8N 3K7, Canada. samaanz@mcmaster.ca.|Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada. samaanz@mcmaster.ca.|Peter Boris Centre for Addiction Research, St. Joseph's Healthcare Hamilton, 100 West 5th Street, Hamilton, ON, L8P 3R2, Canada. samaanz@mcmaster.ca.|Population Genomics Program, Chanchlani Research Centre, McMaster University, 1280 Main St. West, Hamilton, ON, L8S 4L8, Canada. samaanz@mcmaster.ca.
authors.forename: Zainab
authors.initials: Z
authors.lastname: Samaan
mesh_terms: D019969:Amphetamine-Related Disorders / Q000188:drug therapy*; D000697:Central Nervous System Stimulants / Q000009:adverse effects*; D006801:Humans; D008694:Methamphetamine / Q000009:adverse effects
chemical_list: D000697:Central Nervous System Stimulants; D008694:Methamphetamine
keywords: Amphetamine; Central nervous system stimulants; Methamphetamine; Psychostimulants; Substance use disorder