Multiple comparison of different noninvasive brain stimulation and pharmacologic interventions in patients with methamphetamine use disorders: A network meta-analysis of randomized controlled trials

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Wu, Ming-Kung ; Satogami, Kazumi ; Liang, Chih-Sung ; Stubbs, Brendon ; Carvalho, Andre F. ; Brunoni, Andre R. ; Su, Kuan-Pin ; Tu, Yu-Kang ; Wu, Yi-Cheng ; Chen, Tien-Yu ; Li, Dian-Jeng ; Lin, Pao-Yen ; Hsu, Chih-Wei ; Chen, Yen-Wen ; Suen, Mein-Woei ; Zeng, Bing-Yan ; Takahashi, Shun ; Tseng, Ping-Tao ; Li, Cheng-Ta

• Document type: Journal article
• Source: PSYCHIATRY AND CLINICAL NEUROSCIENCES; v. 76, n. 12, p. 11-pg., 2022-10-08.

Abstract

Aim: In recent decades, the prevalence of amphetamine and methamphetamine use disorders has at least doubled in some regions/countries, with accompanying high risks of drug overdose-associated mortality. Noninvasive brain stimulation (NIBS) methods may be effective treatments. However, the comparative efficacy of the NIBS protocol for amphetamine/methamphetamine use disorder (AUD/MUD) remains unknown to date. The aim of this network meta-analysis (NMA) was to compare the efficacy and acceptability of various NIBS methods/protocols for AUD/MUD management. Methods: A frequentist model-based NMA was conducted. We included randomized controlled trials (RCTs) that investigated the efficacy of NIBS and guideline-recommended pharmacologic treatments to reduce craving severity in patients with either AUD or MUD. Results: Twenty-two RCTs including 1888 participants met the eligibility criteria. Compared with the sham/placebo group (study = 19, subjects = 891), a combination of intermittent theta burst stimulation over the left dorsolateral prefrontal cortex (DLPFC) and continuous TBS over the left ventromedial prefrontal cortex (study = 1, subjects = 19) was associated with the largest decreases in craving severity [standardized mean difference (SMD) = -1.50; 95% confidence intervals (95%CIs) = -2.70 to -0.31]. High-frequency repetitive transcranial magnetic stimulation over the left DLPFC was associated with the largest improvements in depression and quality of sleep (study = 3, subjects = 86) (SMD = -2.48; 95%CIs = -3.25 to -1.71 and SMD = -2.43; 95%CIs = -3.38 to -1.48, respectively). The drop-out rate of most investigated treatments did not significantly differ between groups. Conclusion: The combined TBS protocol over the prefrontal cortex was associated with the greatest improvement in craving severity. Since few studies were available for inclusion, additional large-scale randomized controlled trials are warranted. (AU)

• FAPESP's process: 19/06009-6 - Non-implantable neuromodulation therapies: a perspective for the depressed brain
• Grantee: Andre Russowsky Brunoni
• Support Opportunities: Research Projects - Thematic Grants
• FAPESP's process: 18/10861-7 - A Phase-I bilateral project using a sham-controlled, factorial design of transcranial direct current stimulation and theta-burst stimulation to investigate the effects on multimodal assessments of prefrontal cortex functioning
• Grantee: Andre Russowsky Brunoni
• Support Opportunities: Regular Research Grants