Biomarkers of Relapse in Cocaine Use Disorder: A Narrative Review

Abstract

Introduction: Cocaine use disorder is a chronic disease with severe consequences and a high relapse rate. There is a critical need to explore the factors influencing relapse in order to achieve more efficient treatment outcomes. Furthermore, there is a great need for easy-to-measure, repeatable, and valid biomarkers that can predict treatment response or relapse. Methods: We reviewed the available literature on the Pubmed database concerning the biomarkers associated with relapse in CUD, including central nervous system-derived, genetic, immune, oxidative stress, and “other” biomarkers. Results: Fifty-one articles were included in our analysis. Twenty-five imaging brain anatomic and function assessment studies, mostly using fMRI, examined the role of several structures such as the striatum activity in abstinence prediction. There were fewer studies assessing the use of neuropsychological factors, neurotrophins, or genetic/genomic factors, immune system, or oxidative stress measures to predict abstinence. Conclusion: Several biomarkers have been shown to have predictive value. Prospective studies using combined multimodal assessments are now warranted.

Polysubstance addiction and psychiatric, somatic comorbidities among 7,989 individuals with cocaine use disorder: a latent class analysis

“…To date, most molecular and brain imaging studies investigated CoUD-affected individuals as a singular entity, in comparison with control samples or groups of participants affected by other substance use or psychiatric disorders (50, 51). Due to the low prevalence of CoUD in the general population, few investigations of nationally representative cohorts examined differences among individuals with CoUD (52).…”

“…Clinically ascertained CoUD cohorts provide a larger proportion of individuals with the disorder and offer opportunities for more in-depth clinical and phenotypic characterization. As mentioned, molecular and brain imaging studies of CoUD have mostly investigated differences between this group and controls or individuals with other psychiatric conditions (50, 51). Understanding CoUD heterogeneity in the context of PSA and commonly comorbid psychiatric and somatic comorbidities may help inform the development of more precise treatments for this population.…”

Structural and functional pathology in cocaine use disorder with polysubstance use: a multimodal fusion approach

“…Using graph-theory-based multimodal fusion analysis, we found other subcortical regions appearing in addition to the caudate nucleus found in the unimodal analysis. The joint components involved subcortical nodes such as the putamen and thalamus, as well as cerebral cortex such as the anterior/posterior cingulate, parahippocampus, medial temporal, occipital fusiform gyrus, and cuneal cortex, which are commonly associated with CUD (2,4,37).…”

A generalizable functional connectivity signature characterizes brain dysfunction and links to rTMS treatment response in cocaine use disorder

“…Cocaine use disorder (CUD), a disorder marked by compulsive cocaine use, affects over one million people in the United States according to the 2019 national survey on drug use 1,2 . Despite the availability of clinical psychosocial treatments for CUD, the high relapse rate highlights the need for more effective treatments for all CUD patients 3 . A robust and generalizable phenotyping neuroimaging-based biomarker could be helpful to advance our understanding of the neurobiological mechanism and pathophysiology of CUD 4,5 .…”