对酒精使用障碍的药物治疗:系统审查和元分析
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
概括
当与心理干预相结合时,阿卡姆普罗沙特和口服纳尔特克森是有效的第一线治疗方法. 这些药物有助于减少饮酒量,并防止酒精使用障碍患者复发.
科学领域:
- 药理学
- 药物成
- 临床试验
背景情况:
- 酒精使用障碍 (AUD) 是美国的一个重大公共卫生问题,导致患病率和死亡率增加.
- 有效的药物治疗对于治疗AUD和改善患者的结果至关重要.
研究的目的:
- 系统地比较各种药物治疗饮酒障碍的疗效和安全性.
- 为第一线治疗选择提供基于证据的建议.
主要方法:
- 随机临床试验 (RCT) 和前性队列研究的系统审查和元分析.
- 搜索了多个数据库 (PubMed,Cochrane,PsycINFO等) 从2012年11月到2023年8月.
- 提取了疗效 (酒精消耗,复发) 和不良反应的数据;计算了需要治疗的数量.
主要成果:
- 分析了来自118项试验和20976名参与者的数据.
- 艾卡姆普罗沙特和口服纳尔特克森 (50 mg/ d) 显示在防止恢复饮酒方面具有有效性 (NNT分别为11和18).
- 口服纳尔特雷克松 (50 mg/ d) 减少了大量饮酒 (NNT=11);注射纳尔特雷克松减少了饮酒日数.
结论:
- 口服纳尔特克松 (50 mg/ d) 和阿卡姆普罗沙特被推作为AUD的第一线药物治疗.
- 这些药物应该与心理干预一起使用,以获得最佳结果.
- 对于阿坎普罗沙特和纳尔特雷,不良反应包括胃肠道疾病.
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