Meta-analysis: pharmacological treatment of pathological gambling

Abstract

Background: This meta-analysis investigates the efficacy of pharmacological treatments for pathological gambling (PG). Methods: We searched for randomized, placebo-controlled trials examining pharmacotherapy of pathological gamblers. A fixed-effects model was used to calculate the standardized mean difference (SMD) of the benefit of medication (stratified by class) compared to placebo. Secondary analyses examined the effects of publication bias, year of publication and adherence to intention-to-treat (ITT) principles on reported efficacy of interventions. Results: Meta-analysis included 14 trials involving 1024 participants. Opiate antagonists demonstrated a small but significant benefit compared to placebo (SMD = 0.22 ± 0.10 (95% CI: 0.03–0.41), z = 2.3, p = 0.02). The reported efficacy of opiate antagonists was significantly associated with non-adherence to ITT principles in trials and earlier year of publication. Other medications had non-significant effect sizes compared to placebo but similar in magnitude to opiate antagonists. Conclusions: Current trial data provides limited support for the use of any pharmacological agent in the treatment of pathological gambling.

Keywords::

• antipsychotic agents
• naltrexone
• pathological gambling
• pharmacotherapy
• serotonin uptake inhibitors

Financial & competing interests disclosure

The authors acknowledge the support of the National Institutes of Health 1K23MH091240 (MHB), the APIRE/Eli Lilly Psychiatric Research Fellowship (MHB), the Rembrandt Foundation and UL1 RR024139 from the National Center for Research Resources, a component of the National Institutes of Health, and NIH roadmap for Medical Research (MHB). The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.