アルコール使用障害に対する薬剤療法:体系的なレビューとメタ解析
Melissa McPheeters1,2, Elizabeth A O'Connor3, Sean Riley1,4
1RTI International-University of North Carolina at Chapel Hill Evidence-Based Practice Center, Chapel Hill.
JAMA
|November 7, 2023
まとめ
アカンプロサートとナルトレクソンは,精神的介入と組み合わせた場合,アルコール使用障害に対する効果的な第一線治療です. これらの薬はアルコール摂取量を減らし,アルコール使用障害のある人の再発を防ぐのに役立ちます.
科学分野:
- 薬理学について
- 依存症 医学
- 臨床試験
背景:
- アルコール使用障害 (AUD) は,米国における重大な公衆衛生問題であり,罹病率と死亡率を増加させます.
- 有効な薬剤療法がAUDの管理と患者の結果の改善に不可欠です.
研究 の 目的:
- アルコール使用障害に対する様々な薬物療法の有効性と安全性を体系的に比較する.
- 第一線治療の選択肢について 根拠に基づいた勧告を提供すること.
主な方法:
- ランダム化臨床試験 (RCT) と前向きなコホート研究の体系的レビューとメタ分析.
- 複数のデータベース (PubMed,Cochrane,PsycINFOなど) で検索 2012年11月から2023年8月まで
- 治療効果 (アルコール摂取,再発) と有害事象に関する抽出データ; 治療に必要な数値の計算.
主要な成果:
- 118件の臨床試験と20976人の参加者のデータを分析した.
- アカンプロサートとナルトレクソン (50 mg/ d) は,飲酒への再発を予防する効果を示した (NNT=11と18).
- 口服用ナルトレクソン (50 mg/ d) は重度の飲酒率 (NNT=11) を減少させ,注射用ナルトレクソンは飲酒日数を減少させた.
結論:
- 口服用ナルトキソン (50 mg/ d) とアカンプロサートは,AUDの第一線薬剤療法として推奨されます.
- これらの薬は,最適な結果を出すために,心理的介入と併用して使用する必要があります.
- アカンプロサートとナルトキソンの両方の副作用には胃腸障害が含まれます.
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