TY - JOUR
T1 - Opioid antagonists for pharmacological treatment of gambling disorder
T2 - Are they relevant?
AU - IGNACE-consortium
AU - Victorri-Vigneau, Caroline
AU - Spiers, Andrew
AU - Caillet, Pascal
AU - Bruneau, Mélanie
AU - Challet-Bouju, Gaëlle
AU - Grall-Bronnec, Marie
AU - Achab, Sophia
AU - Billieux, Joël
AU - Blaszczynski, Alex
AU - Clark, Luke
AU - Dreher, Jean Claude
AU - Fatseas, Mélina
AU - Giroux, Isabelle
AU - Gorwood, Philip
AU - Goudriaan, Anneke
AU - Hardouin, Jean Benoit
AU - Jimenez-Murcia, Susana
AU - Romo, Lucia
AU - Tessier, Philippe
AU - van den Bos, Ruud
PY - 2018
Y1 - 2018
N2 - Background: To date, no drugs have been approved for gambling disorder. Numerous publications have described the value of opioid antagonists. Indeed, the mesocorticolimbic dopaminergic pathway has been suggested as the underlying cause of reward-seeking behaviour, and it is modulated by the opioid system. Objective: This study aims to evaluate the relevance of opioid antagonists for treating GD. Method: A systematic literature review was conducted. A search of the PubMed electronic database, PsycINFO and the Cochrane Systematic Review Database without any limits was performed. Results: There is little information concerning the effects of opioid antagonists on GD. The total search with “nalmefene and gambling” without any limits revealed only 11 articles. The search with “naltrexone and gambling” without any limits generated 47 articles. Nevertheless, the best available data support the use of opioid antagonists, particularly in individuals with a history of alcohol use disorder or strong gambling urges. Conclusion: Future trials are still needed. Indeed, opioid antagonists effectiveness has been investigated in only a limited number of patients, clinical trials do not reflect the heterogeneity of GD and there is little knowledge of the predictive factors of response to treatments. Moreover, differential affinity to nalmefene for kappa receptors may be associated with a particular effect in a yet to be defined addiction phenotype. Head to head comparisons between naltrexone and nalmefene would be helpful in combining other medication or psychotherapy. The identification of subgroups of patients that are more likely to benefit from opioid antagonists should be a goal.
AB - Background: To date, no drugs have been approved for gambling disorder. Numerous publications have described the value of opioid antagonists. Indeed, the mesocorticolimbic dopaminergic pathway has been suggested as the underlying cause of reward-seeking behaviour, and it is modulated by the opioid system. Objective: This study aims to evaluate the relevance of opioid antagonists for treating GD. Method: A systematic literature review was conducted. A search of the PubMed electronic database, PsycINFO and the Cochrane Systematic Review Database without any limits was performed. Results: There is little information concerning the effects of opioid antagonists on GD. The total search with “nalmefene and gambling” without any limits revealed only 11 articles. The search with “naltrexone and gambling” without any limits generated 47 articles. Nevertheless, the best available data support the use of opioid antagonists, particularly in individuals with a history of alcohol use disorder or strong gambling urges. Conclusion: Future trials are still needed. Indeed, opioid antagonists effectiveness has been investigated in only a limited number of patients, clinical trials do not reflect the heterogeneity of GD and there is little knowledge of the predictive factors of response to treatments. Moreover, differential affinity to nalmefene for kappa receptors may be associated with a particular effect in a yet to be defined addiction phenotype. Head to head comparisons between naltrexone and nalmefene would be helpful in combining other medication or psychotherapy. The identification of subgroups of patients that are more likely to benefit from opioid antagonists should be a goal.
KW - Addictive disorders
KW - Gambling disorder
KW - Nalmefene
KW - Naltrexone
KW - Opioid antagonists
KW - Pathological gambling
UR - http://www.scopus.com/inward/record.url?scp=85045403836&partnerID=8YFLogxK
U2 - https://doi.org/10.2174/1570159X15666170718144058
DO - https://doi.org/10.2174/1570159X15666170718144058
M3 - Review article
C2 - 28721822
SN - 1570-159X
VL - 16
SP - 1418
EP - 1432
JO - Current Neuropharmacology
JF - Current Neuropharmacology
IS - 10
ER -