Topiramate for the Treatment of Methamphetamine Addiction: A Meta-Analysis

Abstract

Background Methamphetamine (MAP) is one of the most abused recreational drug worldwide. Its abuse creates a socio-economic burden across the globe. It is hypothesized to act on various receptors to facilitate the release of catecholamines such as dopamine to provide a euphoric effect. As of date, there are no pharmacologic interventions approved yet for the treatment of MAP addiction. Topiramate is an anti-epileptic drug that works on multiple pathways to modulate catecholamines such as gamma-aminobutyric acid to decrease the effects of stimulants like MAP. Randomized controlled trials done by Elkashef et al and Razeai et al investigated the effectiveness of topiramate in the treatment of MAP addiction. To the authors knowledge, this is the first meta-analysis on topiramate for methamphetamine addiction. Objective This study aims to evaluate the effectiveness of topiramate in the treatment of MAP addiction among diagnoses MAP dependents. Method Randomized controlled trials were searched through databases. Fixed variant analysis was applied to compare dichotomous outcomes. Result Two randomized controlled trials comparing maximum topiramate dose tolerated and placebo were included. The primary outcome was negative MAP use using urine test on the 10th week of study. There was no significant difference between the topiramate and placebo groups (RR 1.03, 95% CI [0.85,1.26], p= 0.73) Conclusion There is insufficient evidence to show that topiramate significantly promotes MAP abstinence on MAP abusers compared to placebo. Recommendation for its use for MAP addiction cannot be established.