Pharmacological management of gambling disorder: A systematic review and network meta-analysis
Background: Clinical guidelines remain unclear on which medications for gambling disorder are to be preferred in terms of efficacy and tolerability. We aimed to compare pharmacological treatments for gambling disorder in terms of efficacy and tolerability, using network meta-analysis (NMA). Methods:...
Saved in:
| Main Authors: | , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2025-02-01
|
| Series: | Comprehensive Psychiatry |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S0010440X24001172 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1841526292280770560 |
|---|---|
| author | Konstantinos Ioannidis Cinzia Del Giovane Charidimos Tzagarakis Jeremy E. Solly Samuel J. Westwood Valeria Parlatini Henrietta Bowden-Jones Jon E. Grant Samuele Cortese Samuel R. Chamberlain |
| author_facet | Konstantinos Ioannidis Cinzia Del Giovane Charidimos Tzagarakis Jeremy E. Solly Samuel J. Westwood Valeria Parlatini Henrietta Bowden-Jones Jon E. Grant Samuele Cortese Samuel R. Chamberlain |
| author_sort | Konstantinos Ioannidis |
| collection | DOAJ |
| description | Background: Clinical guidelines remain unclear on which medications for gambling disorder are to be preferred in terms of efficacy and tolerability. We aimed to compare pharmacological treatments for gambling disorder in terms of efficacy and tolerability, using network meta-analysis (NMA). Methods: Based on our pre-registered protocol [CRD42022329520], a structured search was conducted across broad range of databases, for double-blind randomized controlled trials (RCTs) of medications for gambling disorder. Data were independently extracted by two researchers. We used standardized mean differences (SMD) using Hedges' g to measure the efficacy outcomes, and for the effect for tolerability we used dropout rate due to medication side effects, expressed as odds ratio (OR). Confidence in the network estimates was assessed using the CINeMA framework. We followed the PRISMA-NMA guidelines for this work. Outcomes were gambling symptom severity and quality of life (for efficacy), and tolerability. Findings: We included 22 RCTs in the systematic review and 16 RCTs (n = 977 participants) in the NMA. Compared with placebo, moderate confidence evidence indicated that nalmefene [Standardized Mean Difference (SMD): −0.86; 95 % confidence interval (CI: −1.32,-0.41)] reduced gambling severity, followed by naltrexone (SMD: -0.42; 95 %CI: (−0.85,0.01)). Naltrexone (SMD: -0.50; 95 %CI: (−0.85,-0.14)) and nalmefene (SMD: -0.36; 95 %CI: (−0.72,-0.01) were also more beneficial than placebo in terms of quality of life. Olanzapine and topiramate were not more efficacious than placebo. Nalmefene [Odds Ratio (OR): 7.55; 95 %CI: (2.24–25.41)] and naltrexone (OR: 7.82; 95 %CI: (1.26–48.70)) had significantly higher dropout due to side effects (lower tolerability) compared with placebo. Interpretation: Based on NMA, nalmefene and naltrexone currently have the most supportive evidence for the pharmacological treatment of gambling disorder. Further clinical trials of novel compounds, and analysis of individual participant data are needed, to strengthen the evidence base, and help tailor treatments at the individual patient level. |
| format | Article |
| id | doaj-art-a85a0ae3c63440f78f965ce999a3f2b7 |
| institution | Kabale University |
| issn | 0010-440X |
| language | English |
| publishDate | 2025-02-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Comprehensive Psychiatry |
| spelling | doaj-art-a85a0ae3c63440f78f965ce999a3f2b72025-01-17T04:48:58ZengElsevierComprehensive Psychiatry0010-440X2025-02-01137152566Pharmacological management of gambling disorder: A systematic review and network meta-analysisKonstantinos Ioannidis0Cinzia Del Giovane1Charidimos Tzagarakis2Jeremy E. Solly3Samuel J. Westwood4Valeria Parlatini5Henrietta Bowden-Jones6Jon E. Grant7Samuele Cortese8Samuel R. Chamberlain9Department of Psychiatry, Faculty of Medicine, University of Southampton, UK and Hampshire and Isle of Wight Healthcare NHS Foundation Trust, Southampton, UK; Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK; Corresponding author at: Southern Gambling Service, College Keep, 4-12 Terminus Terrace, Southampton SO14 3DT, United Kingdom.Department of Medical and Surgical Sciences for Children and Adults, University-Hospital of Modena and Reggio Emilia, Modena, Italy and Institute of Primary Health Care (BIHAM), University of Bern, Bern, SwitzerlandDepartment of Psychiatry, School of Medicine, University of Crete, Iraklion, Greece, Organization Against Drugs (OKANA), Athens, Greece and Department of Neuroscience, University of Minnesota, Minneapolis, MN, United StatesCambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK; Department of Psychiatry, University of Cambridge, UKDepartment of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UKCIMH, School of Psychology, University of Southampton, Southampton, UK; Hampshire and Isle of Wight NHS Foundation Trust, UK; Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UKNational Problem Gambling Clinic & National Centre for Gaming Disorders, London, UK; and Department of Psychiatry, University of Cambridge, UK Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UKDepartment of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, USACentre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK; Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK; Solent NHS Trust, Southampton, UK; DiMePRe-J-Department of Precision and Rigenerative Medicine-Jonic Area, University of Bari ''Aldo Moro'', Bari, Italy; Department of Child and Adolescent Psychiatry, New York University Grossman School of Medicine, New York, USADepartment of Psychiatry, Faculty of Medicine, University of Southampton, UK and Hampshire and Isle of Wight Healthcare NHS Foundation Trust, Southampton, UKBackground: Clinical guidelines remain unclear on which medications for gambling disorder are to be preferred in terms of efficacy and tolerability. We aimed to compare pharmacological treatments for gambling disorder in terms of efficacy and tolerability, using network meta-analysis (NMA). Methods: Based on our pre-registered protocol [CRD42022329520], a structured search was conducted across broad range of databases, for double-blind randomized controlled trials (RCTs) of medications for gambling disorder. Data were independently extracted by two researchers. We used standardized mean differences (SMD) using Hedges' g to measure the efficacy outcomes, and for the effect for tolerability we used dropout rate due to medication side effects, expressed as odds ratio (OR). Confidence in the network estimates was assessed using the CINeMA framework. We followed the PRISMA-NMA guidelines for this work. Outcomes were gambling symptom severity and quality of life (for efficacy), and tolerability. Findings: We included 22 RCTs in the systematic review and 16 RCTs (n = 977 participants) in the NMA. Compared with placebo, moderate confidence evidence indicated that nalmefene [Standardized Mean Difference (SMD): −0.86; 95 % confidence interval (CI: −1.32,-0.41)] reduced gambling severity, followed by naltrexone (SMD: -0.42; 95 %CI: (−0.85,0.01)). Naltrexone (SMD: -0.50; 95 %CI: (−0.85,-0.14)) and nalmefene (SMD: -0.36; 95 %CI: (−0.72,-0.01) were also more beneficial than placebo in terms of quality of life. Olanzapine and topiramate were not more efficacious than placebo. Nalmefene [Odds Ratio (OR): 7.55; 95 %CI: (2.24–25.41)] and naltrexone (OR: 7.82; 95 %CI: (1.26–48.70)) had significantly higher dropout due to side effects (lower tolerability) compared with placebo. Interpretation: Based on NMA, nalmefene and naltrexone currently have the most supportive evidence for the pharmacological treatment of gambling disorder. Further clinical trials of novel compounds, and analysis of individual participant data are needed, to strengthen the evidence base, and help tailor treatments at the individual patient level.http://www.sciencedirect.com/science/article/pii/S0010440X24001172GamblingNetwork meta-analysisPharmacotherapytreatment |
| spellingShingle | Konstantinos Ioannidis Cinzia Del Giovane Charidimos Tzagarakis Jeremy E. Solly Samuel J. Westwood Valeria Parlatini Henrietta Bowden-Jones Jon E. Grant Samuele Cortese Samuel R. Chamberlain Pharmacological management of gambling disorder: A systematic review and network meta-analysis Comprehensive Psychiatry Gambling Network meta-analysis Pharmacotherapy treatment |
| title | Pharmacological management of gambling disorder: A systematic review and network meta-analysis |
| title_full | Pharmacological management of gambling disorder: A systematic review and network meta-analysis |
| title_fullStr | Pharmacological management of gambling disorder: A systematic review and network meta-analysis |
| title_full_unstemmed | Pharmacological management of gambling disorder: A systematic review and network meta-analysis |
| title_short | Pharmacological management of gambling disorder: A systematic review and network meta-analysis |
| title_sort | pharmacological management of gambling disorder a systematic review and network meta analysis |
| topic | Gambling Network meta-analysis Pharmacotherapy treatment |
| url | http://www.sciencedirect.com/science/article/pii/S0010440X24001172 |
| work_keys_str_mv | AT konstantinosioannidis pharmacologicalmanagementofgamblingdisorderasystematicreviewandnetworkmetaanalysis AT cinziadelgiovane pharmacologicalmanagementofgamblingdisorderasystematicreviewandnetworkmetaanalysis AT charidimostzagarakis pharmacologicalmanagementofgamblingdisorderasystematicreviewandnetworkmetaanalysis AT jeremyesolly pharmacologicalmanagementofgamblingdisorderasystematicreviewandnetworkmetaanalysis AT samueljwestwood pharmacologicalmanagementofgamblingdisorderasystematicreviewandnetworkmetaanalysis AT valeriaparlatini pharmacologicalmanagementofgamblingdisorderasystematicreviewandnetworkmetaanalysis AT henriettabowdenjones pharmacologicalmanagementofgamblingdisorderasystematicreviewandnetworkmetaanalysis AT jonegrant pharmacologicalmanagementofgamblingdisorderasystematicreviewandnetworkmetaanalysis AT samuelecortese pharmacologicalmanagementofgamblingdisorderasystematicreviewandnetworkmetaanalysis AT samuelrchamberlain pharmacologicalmanagementofgamblingdisorderasystematicreviewandnetworkmetaanalysis |