美沙酮维持治疗中按剂量和给药策略留存率的荟萃分析。
A meta-analysis of retention in methadone maintenance by dose and dosing strategy.
作者信息
Bao Yan-Ping, Liu Zhi-Min, Epstein David H, Du Cun, Shi Jie, Lu Lin
机构信息
National Institute on Drug Dependence, Peking University, Beijing, China.
出版信息
Am J Drug Alcohol Abuse. 2009;35(1):28-33. doi: 10.1080/00952990802342899.
OBJECTIVE
To estimate, via meta-analysis, the influence of different methadone dose ranges and dosing strategies on retention rates in methadone maintenance treatment (MMT).
METHODS
A systematic literature search identified 18 randomized controlled trials (RCTs) evaluating methadone dose and retention. Retention was defined as the percentage of patients remaining in treatment at a specified time point. After initial univariate analyses of retention by Pearson chi-squares, we used multilevel logistic regression to calculate summary odds ratios (ORs) and 95% confidence intervals for the effects of methadone dose (above or below 60 mg/day), flexible vs. fixed dosing strategy, and duration of follow-up.
RESULTS
The total number of opioid-dependent participants in the 18 studies was 2831, with 1797 in MMT and 1034 receiving alternative mediations or placebo. Each variable significantly predicted retention with the other variables controlled for. Retention was greater with methadone doses > or = 60 than with doses < 60 (OR: 1.74, 95% CI: 1.43-2.11). Similarly, retention was greater with flexible-dose strategies than with fixed-dose strategies (OR: 1.72, 95% CI: 1.41-2.11).
CONCLUSIONS
Higher doses of methadone and individualization of doses are each independently associated with better retention in MMT.
目的
通过荟萃分析评估不同美沙酮剂量范围和给药策略对美沙酮维持治疗（MMT）留存率的影响。
方法
一项系统文献检索确定了18项评估美沙酮剂量与留存率的随机对照试验（RCT）。留存率定义为在特定时间点仍接受治疗的患者百分比。在通过Pearson卡方对留存率进行初步单变量分析后，我们使用多水平逻辑回归来计算美沙酮剂量（高于或低于60毫克/天）、灵活给药策略与固定给药策略以及随访持续时间影响的汇总比值比（OR）和95%置信区间。
结果
18项研究中阿片类药物依赖参与者总数为2831人，其中1797人接受MMT，1034人接受替代药物或安慰剂。在控制其他变量的情况下，每个变量都能显著预测留存率。美沙酮剂量≥60毫克时的留存率高于剂量<60毫克时（OR：1.74，95%置信区间：1.43 - 2.11）。同样，灵活剂量策略的留存率高于固定剂量策略（OR：1.72，95%置信区间：1.41 - 2.11）。
结论
较高剂量的美沙酮和剂量个体化各自独立地与MMT中更好的留存率相关。
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