A gender‐based secondary analysis of the ADAPT‐2 combination naltrexone and bupropion treatment for methamphetamine use disorder trial

• Published in: Addiction (Abingdon, England) England), 2023-07, Vol.118 (7), p.1320-1328
• Main Authors: Levander, Ximena A., Carmody, Thomas, Cook, Ryan R., Potter, Jennifer S., Trivedi, Madhukar H., Korthuis, Philip Todd, Shoptaw, Steven
• Format: Article
• Language: English
• Subjects: Adult; Amphetamine‐related disorders; Antidepressants; Birth control; Bupropion; Bupropion - therapeutic use; Central Nervous System Stimulants - therapeutic use; clinical trial; Contraception; Double-Blind Method; Double-blind studies; Drug Therapy, Combination; Female; Gender; Gender differences; Humans; Intervention; Male; Methamphetamine; Naltrexone; Placebos; Pregnancy; Responsiveness; Sex differences; Susceptibility; Urine tests; women; women's health
• ISSN: 0965-2140; 1360-0443; 1360-0443
• DOI: 10.1111/add.16163

Background and Aims Socio‐cultural (gender) and biological (sex)‐based differences contribute to psychostimulant susceptibility, potentially affecting treatment responsiveness among women with methamphetamine use disorder (MUD). The aims were to measure (i) how women with MUD independently and compared with men respond to treatment versus placebo and (ii) among women, how the hormonal method of contraception (HMC) affects treatment responsiveness. Design This was a secondary analysis of ADAPT‐2, a randomized, double‐blind, placebo‐controlled, multicenter, two‐stage sequential parallel comparison design trial. Setting United States. Participants This study comprised 126 women (403 total participants); average age = 40.1 years (standard deviation = 9.6) with moderate to severe MUD. Interventions Interventions were combination intramuscular naltrexone (380 mg/3 weeks) and oral bupropion (450 mg daily) versus placebo. Measurements Treatment response was measured using a minimum of three of four negative methamphetamine urine drug tests during the last 2 weeks of each stage; treatment effect was the difference between weighted treatment responses of each stage. Findings At baseline, women used methamphetamine intravenously fewer days than men [15.4 versus 23.1% days, P = 0.050, difference = −7.7, 95% confidence interval (CI) = −15.0 to −0.3] and more women than men had anxiety (59.5 versus 47.6%, P = 0.027, difference = 11.9%, 95% CI = 1.5 to 22.3%). Of 113 (89.7%) women capable of pregnancy, 31 (27.4%) used HMC. In Stage 1 29% and Stage 2 5.6% of women on treatment had a response compared with 3.2% and 0% on placebo, respectively. A treatment effect was found independently for females and males (P