Introduction Amphetamine-type stimulants (ATSs) are related to significant harm worldwide, with limited effective pharmacological treatments for ATS use disorder (ATSUD). Modafinil has been explored as a potential treatment for ATSUD. This systematic review and meta-analysis (PROSPERO ID: CRD42023388487) aimed to evaluate the efficacy and safety of modafinil for the treatment of ATSUD.Methods A comprehensive search of major indexing sources and trial registries, from inception to search date, was conducted on February 15, 2023, and updated on October 31, 2023. Eligible studies were randomized placebo-controlled trials (RCTs) of modafinil in individuals meeting the criteria for the Diagnostic and Statistical Manual of Mental Disorders, fourth and fifth editions, diagnoses of ATSUD. Eligible studies were assessed for risk of bias, using the Cochrane Risk of Bias tool. The primary outcome included the effect of modafinil on ATS use. Secondary outcomes included retention in treatment, ATS craving, treatment discontinuation due to adverse events (AEs), and serious AEs. Subgroup analysis by modafinil dose was conducted where appropriate. Risk ratio (RR) or Peto's odds ratio (OR) was calculated for the meta-analysis of dichotomous variables and standardized mean difference (SMD) was calculated for the random-effect meta-analysis of continuous variables.Results Five RCTs (N = 451 participants) were included. Modafinil did not significantly impact ATS use (RR = 0.99; 95% CI, 0.97 to 1.02; p = 0.655), retention in treatment (RR = 1.02; 95% CI, 0.91 to 1.14; p = 0.799), ATS craving (SMD = -0.36; 95% CI, -1.19 to 0.47; p = 0.398), or treatment discontinuation due to AEs (Peto's OR = 0.48; 95% CI, 0.20 to 1.14; p = 0.100). These results were consistent across subgroup analyses. More episodes of serious AEs were reported in the modafinil group than in the placebo group, at higher doses (Peto's OR = 4.80; 95% CI, 1.18 to 19.56, p = 0.029).Conclusion There is currently no evidence suggesting that modafinil has a statistically significant effect on efficacy outcomes in populations with ATSUD. Continued research into effective treatments and harm reduction strategies for ATSUD is essential. Introduction Les stimulants de type amph & eacute;tamine (STA) sont li & eacute;s & agrave; des m & eacute;faits importants dans le monde entier. Les traitements pharmacologiques efficaces pour les troubles li & eacute;s & agrave; l'usage de STA (TUSTA) sont limit & eacute;s. Le modafinil a & eacute;t & eacute; explor & eacute; comme traitement potentiel pour le TUSTA. Cette revue syst & eacute;matique et m & eacute;ta-analyse (PROSPERO ID : CRD42023388487) visait & agrave; & eacute;valuer l'efficacit & eacute; et la s & eacute;curit & eacute; du modafinil pour le traitement du TUSTA.M & eacute;thodes Une recherche compl & egrave;te des principales sources d'indexation et registres d'essais, depuis leur cr & eacute;ation jusqu'& agrave; la date de recherche, a & eacute;t & eacute; men & eacute;e le 15 f & eacute;vrier 2023 et mise & agrave; jour le 31 octobre 2023. Les & eacute;tudes admissibles & eacute;taient des essais randomis & eacute;s contr & ocirc;l & eacute;s (ERC) par placebo de modafinil chez des personnes satisfaisant aux crit & egrave;res diagnostics de TUSTA du Manuel diagnostique et statistique des troubles mentaux, 4e et 5e & eacute;dition. Les & eacute;tudes admissibles ont & eacute;t & eacute; & eacute;valu & eacute;es quant au risque de biais, & agrave; l'aide de l'Outil d'& eacute;valuation du risque de biais de Cochrane. Le crit & egrave;re de jugement principal & eacute;taait l'effet du modafinil sur l'utilisation des STA. Les crit & egrave;res de jugement secondaires comprenaient la r & eacute;tention dans le traitement, l'envie de consommer des STA, la discontinuation du traitement en raison d'& eacute;v & eacute;nements ind & eacute;sirables (EI) et des EI s & eacute;rieux. Une analyse de sous-groupe par dose de modafinil a & eacute;t & eacute; r & eacute;alis & eacute;e lorsque cela & eacute;tait ad & eacute;quat. Le rapport de risque (RR) ou rapport de cotes (RC) de Peto a & eacute;t & eacute; calcul & eacute; pour la m & eacute;ta-analyse des variables dichotomiques et la diff & eacute;rence moyenne standardis & eacute;e (DMS) a & eacute;t & eacute; calcul & eacute;e pour la m & eacute;ta-analyse & agrave; effet al & eacute;atoire des variables continues.R & eacute;sultats Cinq ERC (N = 451 participants) ont & eacute;t & eacute; inclus. Le modafinil n'a pas eu d'effet significatif sur l'usage des STA (RR = 0,99; IC & agrave; 95% = 0,97 & agrave; 1,02; p = 0,655), la r & eacute;tention en traitement (RR = 1,02; IC & agrave; 95% = 0,91 & agrave; 1,14 ; p = 0.799), l'envie de consommer des STA (SMD = -0,36; IC & agrave; 95% = -1,19 & agrave; 0,47; p = 0,398), ou la discontinuation du traitement en raison des EI (RC de Peto = 0.48; IC & agrave; 95% = 0,20 & agrave; 1,14; p = 0,100. Ces r & eacute;sultats & eacute;taient coh & eacute;rents dans toutes les analyses de sous-groupes. Plus d'& eacute;pisodes d'EI graves ont & eacute;t & eacute; rapport & eacute;s dans le groupe modafinil que dans le groupe placebo, & agrave; des doses plus & eacute;lev & eacute;es (RC de Peto = 4,80; IC & agrave; 95% = 1,18 & agrave; 19,56, p = 0,029).Conclusion Il n'existe actuellement aucune preuve sugg & eacute;rant que le modafinil ait un effet statistiquement significatif sur les r & eacute;sultats d'efficacit & eacute; dans les populations atteintes de TUSTA. La recherche continue sur les traitements efficaces et les strat & eacute;gies de r & eacute;
