TY - JOUR
T1 - Aripiprazole for cocaine abstinence
T2 - A randomized-controlled trial with ecological momentary assessment
AU - Moran, Landhing M.
AU - Phillips, Karran A.
AU - Kowalczyk, William J.
AU - Ghitza, Udi E.
AU - Agage, Daniel A.
AU - Epstein, David H.
AU - Preston, Kenzie L.
N1 - Publisher Copyright:
Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2017/2/1
Y1 - 2017/2/1
N2 - Aripiprazole blocks psychostimulant seeking in a rat model of relapse. However, in humans, it may increase ongoing use. We tested aripiprazole specifically for relapse prevention. Methadone-maintained outpatients who were abstinent from cocaine in weeks 11-12 were randomized to double-blind aripiprazole (15mg daily) or placebo in weeks 13-27 after 12 weeks of contingency management. Participants reported craving through ecological momentary assessment. We stopped the trial because very few (18/41) participants fulfilled the abstinence criterion. The results suggested that aripiprazole delayed lapse [hazard ratio (HR)=0.45, 95% confidence interval (CI)=0.14-1.42, P=0.17] and relapse (HR=0.31, 95% CI=0.07-1.27, P=0.10), but the effects did not reach statistical significance. Unexpectedly, the proportion of participants reporting cocaine craving was higher in the aripiprazole group (Fisher's exact P=0.026), although the frequency of craving was similar in the aripiprazole and placebo groups (1.89 vs. 1.16%, reffect=0.43, 95% CI=-0.08-0.76). The results suggest that in recently abstinent cocaine users, aripiprazole might delay relapse, but might also slightly increase craving. Difficulty in trial implementation underscores the fact that initial abstinence from cocaine is not a trivial hurdle.
AB - Aripiprazole blocks psychostimulant seeking in a rat model of relapse. However, in humans, it may increase ongoing use. We tested aripiprazole specifically for relapse prevention. Methadone-maintained outpatients who were abstinent from cocaine in weeks 11-12 were randomized to double-blind aripiprazole (15mg daily) or placebo in weeks 13-27 after 12 weeks of contingency management. Participants reported craving through ecological momentary assessment. We stopped the trial because very few (18/41) participants fulfilled the abstinence criterion. The results suggested that aripiprazole delayed lapse [hazard ratio (HR)=0.45, 95% confidence interval (CI)=0.14-1.42, P=0.17] and relapse (HR=0.31, 95% CI=0.07-1.27, P=0.10), but the effects did not reach statistical significance. Unexpectedly, the proportion of participants reporting cocaine craving was higher in the aripiprazole group (Fisher's exact P=0.026), although the frequency of craving was similar in the aripiprazole and placebo groups (1.89 vs. 1.16%, reffect=0.43, 95% CI=-0.08-0.76). The results suggest that in recently abstinent cocaine users, aripiprazole might delay relapse, but might also slightly increase craving. Difficulty in trial implementation underscores the fact that initial abstinence from cocaine is not a trivial hurdle.
KW - Cocaine
KW - D2 partial agonists
KW - Ecological momentary assessment
KW - Human
KW - Relapse prevention
UR - http://www.scopus.com/inward/record.url?scp=84991517696&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84991517696&partnerID=8YFLogxK
U2 - 10.1097/FBP.0000000000000268
DO - 10.1097/FBP.0000000000000268
M3 - Article
C2 - 27755017
AN - SCOPUS:84991517696
SN - 0955-8810
VL - 28
SP - 63
EP - 73
JO - Behavioural Pharmacology
JF - Behavioural Pharmacology
IS - 1
ER -