在门诊环境中为患有酒精使用障碍的成年人提供药物治疗:系统性审查和元分析
Daniel E Jonas1, Halle R Amick2, Cynthia Feltner1
1Department of Medicine, University of North Carolina, Chapel Hill2Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill.
JAMA
|May 15, 2014
概括
这次审查发现,阿坎普酸和口服纳尔特雷克松都有助于减少酒精复发. 在控制酒精消费方面,这些药物之间没有观察到显著差异,这表明了剂量和副作用指南选择等因素.
科学领域:
- 药理学 药理学是指药理学的学科.
- 成 药物 药物 药物 药物
- 临床试验 临床试验
背景情况:
- 酒精使用障碍 (AUD) 是一个重要的公共卫生问题,导致相当大的发病率和死亡率.
- 尽管有有效的治疗方法,但AUD仍未得到充分治疗,药物使用特别不足.
研究的目的:
- 系统地审查和元分析成年人诊断出酒精使用障碍的药物的疗效和安全性.
- 评估美国FDA批准的药物和其他用于AUD治疗的药物.
主要方法:
- 在多个数据库 (PubMed,Cochrane Library,PsycINFO,CINAHL,EMBASE) 和临床试验注册表中进行了全面的搜索.
- 选择了至少12周的随机临床试验 (RCT) 和头对头前性队列研究.
- 使用随机效应模型进行了元分析,以计算需要治疗的数量 (NNTs) 并评估酒精消耗,伤害和死亡率等结果.
主要成果:
- 该审查包括122个RCT和1个队列研究 (22,803名参与者),主要评估了阿卡姆普罗沙特和纳尔德.
- 艾卡姆普罗沙特 (NNT=12) 和口服纳尔特雷 (NNT=12-20) 都与饮酒回归的减少有关.
- 在防止回归或重度饮酒方面,在阿坎普罗沙特和口服纳尔特雷克松之间没有发现显著的差异. 注射性纳尔特雷克松显示,减少了大量饮酒的日子.
- 标签外的药物,如纳尔梅芬和托皮拉,有适度的证据表明改善了消费结果.
结论:
- 阿卡姆普罗沙特和口服纳尔特雷在减少酒精使用障碍的复发方面是有效的.
- 直接比较显示,在控制酒精消费方面,阿坎普罗沙特和纳尔特雷之间没有显著差异.
- 治疗选择可能由包括剂量频率,潜在不良事件和药物可用性在内的因素来指导.
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