Lisdexamphetamine associated with improved outcomes for those with amphetamine disorders

The use of lisdexamphetamine was associated with improved outcomes in those with amphetamine and methamphetamine use disorders, researchers reported in JAMA Psychiatry.

Currently, there are no medications approved for the treatment of amphetamine or methamphetamine dependence, Milja Heikkinen, MD, of the University of Eastern Finland, and colleagues wrote.

Heikkinen and colleagues sought to investigate the association between pharmacotherapies and hospitalization and mortality outcomes in people with amphetamine and methamphetamine use disorders.

The authors conducted a nationwide register-based cohort study from July 2006 through December 2018, with a median follow-up time of 3.9 years. All residents aged 16 to 64 years, who lived in Sweden with a registered first-time diagnosis of amphetamine and methamphetamine use disorder were identified from nationwide registers of inpatient care.

Primary outcomes were identified through hospitalization due to substance use disorders and any hospitalization or death, which were analyzed through models that compared use and nonuse periods if 17 specific medications or medication classes in the same individual.

A total of 13,965 individuals (69.3% male; mean age, 34.4 years) were included in the cohort. During follow-up, 54% of participants were taking antidepressants, 43.7% were taking benzodiazepines, 36.3% antipsychotics, 28.2% ADHD medications (10.8% of which were taking lisdexamphetamine), 20.5% substance use disorder medications, and 12.2% mood stabilizers.

A total of 10,341 (74%) were hospitalized due to a substance use disorder, 11,492 (82.3%) were hospitalized due to any cause or died, and1,321 (9.5%) died of any cause. Lisdexamphetamine was the only medication in the study that was significantly associated with a decrease in risk of any of these three outcomes: hospitalization for a substance use disorder (aHR, 0.82; 95% CI, 0.72-0.94), any hospitalization or death (aHR, 0.86; 95% CI, 0.78-0.95), or for all-cause mortality (aHR, 0.43; 95% CI, 0.24-0.77).

Methylphenidate use was also associated with lower all-cause mortality (aHR, 0.56; 95% CI, 0.43-0.74).

The use of benzodiazepines was associated with a significantly higher risk for substance use disorder hospitalizations (aHR, 1.17; 95% CI, 1.12-1.22), any hospitalization or death (aHR, 1.20; 95% CI, 1.17-1.24), as well as all-cause mortality (aHR, 1.39; 95% CI, 1.2-1.6).

In addition, the use of antidepressants or antipsychotics were associated with a slight increase in risk for substance use hospitalizations (antidepressants, aHR, 1.07; 95% CI, 1.03-1.11; antipsychotics, aHR, 1.05; 95% CI, 1.01-1.09), as well as any hospitalization or death (antidepressants, aHR, 1.10; 95% CI, 1.06-1.14; antipsychotics, aHR, 1.06; 95% CI, 1.03-1.10).

“Overall, the results are generalizable for real-world patients and offer new and useful information on the association of medications widely used in persons with [methamphetamine or amphetamine use disorders] with long-term health outcomes,” Heikkinen and colleagues wrote.