Response to Hall <i>et al</i>.: Prescription psychostimulants for amphetamine‐type stimulant use disorder ‐ acknowledging challenges but not giving up on its potential cost‐effectiveness
Notice bibliographique
Résumé
We appreciate the comments by Hall et al. [1] on our meta-analysis [2]. They have raised some very legitimate concerns related to the development of new treatments for amphetamine-type stimulant (ATS) use disorder (ATSUD). Challenges pertaining to the feasibility of trialing psychostimulants for ATSUD, to the differences between the tentative stimulant agonist therapy and established opioid agonist therapy (OAT), and to the certainty of the evidence through the pooling of results from studies with small sample sizes were already mentioned in our meta-analysis and shared by our group of authors. Hall et al. [1] have also criticized the justification for further trials of high-dose stimulants, mainly because of the small effect size observed for craving and the lack of any effect on other outcomes in the main analysis. However, they ignored the statistically significant results of the ATS use by urinalysis in the sensitivity analysis and the increase of the risk reduction of ATS use from a small (11%) to a moderate effect (29%) when including the only study [3] with high-dose methylphenidate (180 mg/day) in the subgroup analysis by medication dosage. While this significant signal is based on a single study conducted in an attention deficit hyperactivity disorder (ADHD)-only population, it brings the urge to more endeavors on trialing high-dose prescription psychostimulants, especially in the context of a disorder for which few, if any, interventions have proven very efficacious to date. We completely agree on the concerns with the challenges related to conducting trials with high-dose psychostimulants, both in terms of feasibility and the risk–benefit ratio. That is precisely why we advocated for an acceleration of the research effort in this field and the use of strategies to improve retention while mitigating risks, such as psychostimulant formulations with longer duration of action, and combination with psychosocial interventions [4]. The upcoming research can also elaborate on not-well-studied patient-reported outcomes, especially quality of life, rather than only abstinence-based outcomes, while also testing new supervision strategies that may be more cost-effective. In conclusion, we are on the same page with Hall et al. [1] regarding the challenges that come with trialing high-dose psychostimulants for ATSUD, such as the feasibility and safety of the intervention and the need for adequate power and higher retention rates. However, we believe that further high-quality trials of psychostimulants should not be discouraged, as psychostimulants possess one of the only signals of efficacy among well-studied medications for the treatment of ATSUD. Whether or not these efforts will result in the provision of effective management of ATSUD as does OAT for opioid use disorder is not known. However, given the burden of ATSUD for those who live with such disorders, their family and loved ones as well as society, the positive signal highlighted by our meta-analysis, even if it comes with challenges and potential concerns, merits further exploration and rigorous assessment. Heidar Sharafi: Conceptualization (equal); writing—original draft (equal); writing—review and editing (equal). Didier Jutras-Aswad: Conceptualization (equal); writing—original draft (equal); writing—review and editing (equal). Not applicable. D.J.A. receives study material from Cardiol Therapeutics for a clinical trial funded by the Quebec Ministry of Health and Social Services and holds a clinical scientist career award from Fonds de Recherche du Québec (FRQS).
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,001 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,001 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,001 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».