一项关于喹硫平治疗 A 型和 B 型酒精中毒的双盲、安慰剂对照试验。
A double-blind, placebo-controlled pilot trial of quetiapine for the treatment of Type A and Type B alcoholism.
作者信息
Kampman Kyle M, Pettinati Helen M, Lynch Kevin G, Whittingham Tom, Macfadden Wayne, Dackis Charles, Tirado Carlos, Oslin David W, Sparkman Thorne, O'Brien Charles P
机构信息
Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA.
出版信息
J Clin Psychopharmacol. 2007 Aug;27(4):344-51. doi: 10.1097/JCP.0b013e3180ca86e5.
BACKGROUND
Atypical antipsychotics may be useful in the treatment of alcohol dependence. Human trials suggest that atypical antipsychotics may reduce alcohol craving and consumption, especially among patients with comorbid psychopathology. Therefore, these medications may be more useful for treating more severely affected alcoholics, such as patients with Type B alcoholism. Type B alcoholics are characterized by an early age of onset of problem drinking, high severity of alcohol dependence, increased psychopathology, and treatment-resistance. Quetiapine is an atypical antipsychotic with a favorable side effect profile, and may be a promising medication for the treatment of alcohol dependence, particularly Type B alcoholism.
METHODS
Male and female alcoholics (33 Type A and 28 Type B) were included in a 12-week, double-blind, placebo-controlled trial. After detoxification, patients were randomized to receive quetiapine (n = 29), 400 mg/d at bedtime, or placebo (n = 32). The primary outcome measure was the quantity and frequency of alcohol consumption, measured by the timeline follow back.
RESULTS
Forty-seven patients (77%) completed the trial, with no significant between-group differences in treatment retention. Nine quetiapine-treated patients (31%) maintained complete abstinence compared with 2 placebo-treated patients (6%) (chi(2) = 6.3, P = 0.012). There was a significant interaction between quetiapine and alcoholic subtype. As predicted, quetiapine- versus placebo-treated Type B alcoholics had significantly fewer days of drinking and fewer days of heavy drinking. Alcohol craving was also significantly reduced in quetiapine-treated compared with placebo-treated Type B alcoholics. Among Type A alcoholics, quetiapine provided no advantage over placebo in improving drinking outcomes.
CONCLUSIONS
Quetiapine may be effective for the treatment of alcohol dependence, particularly in the more complicated Type B, early-onset alcoholics.
背景
非典型抗精神病药物可能对酒精依赖的治疗有用。人体试验表明，非典型抗精神病药物可能会减少对酒精的渴望和饮酒量，尤其是在伴有共病精神病理学的患者中。因此，这些药物可能对治疗受酒精影响更严重的酗酒者更有用，例如B型酒精中毒患者。B型酒精中毒患者的特征是饮酒问题发病年龄早、酒精依赖严重程度高、精神病理学增加以及治疗抵抗性。喹硫平是一种具有良好副作用谱的非典型抗精神病药物，可能是治疗酒精依赖，特别是B型酒精中毒的一种有前景的药物。
方法
男性和女性酗酒者（33例A型和28例B型）纳入一项为期12周的双盲、安慰剂对照试验。脱毒后，患者被随机分配接受喹硫平（n = 29），睡前400 mg/d，或安慰剂（n = 32）。主要结局指标是通过时间线追溯法测量的饮酒量和饮酒频率。
结果
47例患者（77%）完成试验，治疗保留率在组间无显著差异。9例接受喹硫平治疗的患者（31%）保持完全戒酒，而接受安慰剂治疗的患者为2例（6%）（χ² = 6.3，P = 0.012）。喹硫平和酒精亚型之间存在显著交互作用。如预期的那样，与接受安慰剂治疗的B型酒精中毒患者相比，接受喹硫平治疗的患者饮酒天数和重度饮酒天数显著减少。与接受安慰剂治疗的B型酒精中毒患者相比，接受喹硫平治疗的患者对酒精的渴望也显著降低。在A型酒精中毒患者中，喹硫平在改善饮酒结局方面并不比安慰剂更具优势。
结论
喹硫平可能对酒精依赖的治疗有效，特别是在更复杂的早发性B型酗酒者中。
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