Topiramate for cocaine dependence: a systematic review and meta‐analysis of randomized controlled trials

Abstract

Evidence does not currently support the use of topiramate to improve treatment retention for cocaine use disorder, although it may extend cocaine abstinence with a similar risk of adverse events compared with placebo.

How can we investigate the role of topiramate in the treatment of cocaine use disorder more thoroughly?

“…We read with interest Darke & Farrell’s [1] commentary on our meta-analysis of topiramate published in the eighth issue of 2016 [2]. To elaborate on some of the ideas raised by the commentary, we focus our response on the question of why some studies implied a benefit and others did not.…”

Commentary on Singh et al. (2016): Still searching for the answer

“…In their Introduction, Singh and colleagues note that cocaine dependence is a world‐wide clinical and public health problem . Indeed, this has been the case for a considerable time, with the first cocaine ‘epidemic’ being seen in during the 1920s.…”

“…The lack of progress in finding effective pharmacotherapies over this period is remarkable. Drugs trialled have included antidepressants, antipsychotics, dopamine agonists and other psychostimulants . To date, no drug has shown unequivocal efficacy in reducing use and craving.…”

“…Singh et al . 's review of the anticonvulsant topiramate continues this long‐standing pattern, with the results indicating that the drug did not improve treatment retention but may, possibly, improve abstinence in the short term. There was certainly no compelling evidence that this was the pharmacological solution so desperately sought.…”

“…The work by Singh et al is an important contribution. It is only by analyses of this kind, taking stock across a number of studies, that the true picture emerges.…”