Targeting and Modulation of Oxidative Stress Biomarkers by NDRI Therapy in Heroin- Dependent Patients: Insights from a case-control study in Pakistan

Background: Heroin addiction disrupts cellular redox balance, elevating oxidative stress. Norepinephrine-Dopamine Reuptake Inhibitors (NDRIs) may offer therapeutic value through modulation of oxidative markers. Objectives: (1) To compare oxidative stress markers (GSH, MDA) and anthropometric indices (BMI, WHR) between heroin addicts and healthy controls; (2) To assess the changes in oxidative stress markers (GSH, MDA) and anthropometric indices parameters after 8 weeks of NDRI (Bupropion) treatment. Methods: A case control study was conducted with 105 participants divided into three groups: healthy controls, Heroin addicts NDRI-treated, Non-addicts NDRI-treated. Serum GSH and MDA, and anthropometric indices were measured. Results were presented in tabular format, with mean ± SD for continuous variables and frequencies (percentages) for categorical variables. Statistical comparisons were reported with mean differences, p-values, and effect sizes where applicable. A p-value of <0.05 was considered statistically significant. Results : To compare continuous variables (e.g., age, BMI, WHR, GSH, and MDA) across the three groups (Control, Heroin Addicts NDRI, and NDRI Non-Addicts), a one-way analysis of variance (ANOVA) was performed. The assumption of homogeneity of variances was assessed using Levene's test. For post-hoc comparisons, the Games-Howell test was applied, as it is robust to violations of homogeneity variances and unequal group sizes. The chi-square (χ²) test was used to compare categorical variables (e.g., gender distribution) across the groups. This test evaluates the association between group membership and categorical outcomes. The levels of oxidative stress markers (GSH and MDA) were compared across the groups using one-way ANOVA. Post-hoc analyses were conducted using the Games-Howell test to identify specific group differences. The results were reported as mean differences with corresponding p-values. A p-value of <0.05 was considered statistically significant for all analyses. Effect sizes were also calculated to assess the magnitude of differences between groups, providing additional context to the statistical significance. Clinical trial numbers are not applicable. Conclusion: NDRIs demonstrate potential in reducing oxidative stress and altering body composition in heroin addicts. A multidisciplinary rehabilitation strategy combining pharmacological and lifestyle interventions is warranted.