Minozzi Silvia, Amato Laura, Vecchi Simona, Davoli Marina
Department of Epidemiology, ASL RM/E, Via di Santa Costanza, 53, Rome, Italy, 00198.
Cochrane Database Syst Rev. 2010 Mar 17(3):CD005064. doi: 10.1002/14651858.CD005064.pub3.
Alcohol abuse and dependence represents a most serious health problem worldwide with major social, interpersonal and legal interpolations. Besides benzodiazepines, anticonvulsants are often used for the treatment of alcohol withdrawal symptoms. Anticonvulsants drugs are indicated for the treatment of alcohol withdrawal syndrome, alone or in combination with benzodiazepine treatments. In spite of the wide use, the exact role of the anticonvulsants for the treatment of alcohol withdrawal has not yet bee adequately assessed.
To evaluate the effectiveness and safety of anticonvulsants in the treatment of alcohol withdrawal.
We searched Cochrane Drugs and Alcohol Group' Register of Trials (December 2009), PubMed, EMBASE, CINAHL (1966 to December 2009), EconLIT (1969 to December 2009). Parallel searches on web sites of health technology assessment and related agencies, and their databases.
Randomized controlled trials (RCTs) examining the effectiveness, safety and overall risk-benefit of anticonvulsants in comparison with a placebo or other pharmacological treatment. All patients were included regardless of age, gender, nationality, and outpatient or inpatient therapy.
Two authors independently screened and extracted data from studies.
Fifty-six studies, with a total of 4076 participants, met the inclusion criteria. Comparing anticonvulsants with placebo, no statistically significant differences for the six outcomes considered.Comparing anticonvulsant versus other drug, 19 outcomes considered, results favour anticonvulsants only in the comparison carbamazepine versus benzodiazepine (oxazepam and lorazepam) for alcohol withdrawal symptoms (CIWA-Ar score): 3 studies, 262 participants, MD -1.04 (-1.89 to -0.20), none of the other comparisons reached statistical significance.Comparing different anticonvulsants no statistically significant differences in the two outcomes considered.Comparing anticonvulsants plus other drugs versus other drugs (3 outcomes considered), results from one study, 72 participants, favour paraldehyde plus chloral hydrate versus chlordiazepoxide, for the severe-life threatening side effects, RR 0.12 (0.03 to 0.44).
AUTHORS' CONCLUSIONS: Results of this review do not provide sufficient evidence in favour of anticonvulsants for the treatment of AWS. There are some suggestions that carbamazepine may actually be more effective in treating some aspects of alcohol withdrawal when compared to benzodiazepines, the current first-line regimen for alcohol withdrawal syndrome. Anticonvulsants seem to have limited side effects, although adverse effects are not rigorously reported in the analysed trials.
酒精滥用和依赖是全球最严重的健康问题之一，具有重大的社会、人际和法律影响。除了苯二氮䓬类药物外，抗惊厥药也常用于治疗酒精戒断症状。抗惊厥药物可单独或与苯二氮䓬类药物联合用于治疗酒精戒断综合征。尽管使用广泛，但抗惊厥药在治疗酒精戒断中的确切作用尚未得到充分评估。
评估抗惊厥药治疗酒精戒断的有效性和安全性。
我们检索了Cochrane药物与酒精研究组试验注册库（2009年12月）、PubMed、EMBASE、CINAHL（1966年至2009年12月）、EconLIT（1969年至2009年12月）。同时在卫生技术评估和相关机构的网站及其数据库上进行平行检索。
随机对照试验（RCT），比较抗惊厥药与安慰剂或其他药物治疗的有效性、安全性和总体风险效益。纳入所有患者，不考虑年龄、性别、国籍以及门诊或住院治疗情况。
两位作者独立筛选并从研究中提取数据。
56项研究，共4076名参与者，符合纳入标准。将抗惊厥药与安慰剂比较，所考虑的6项结果无统计学显著差异。将抗惊厥药与其他药物比较，考虑19项结果，仅在卡马西平与苯二氮䓬类药物（奥沙西泮和劳拉西泮）治疗酒精戒断症状（CIWA-Ar评分）的比较中结果支持抗惊厥药：3项研究，262名参与者，MD -1.04（-1.89至-0.20），其他比较均未达到统计学显著差异。比较不同抗惊厥药，所考虑的2项结果无统计学显著差异。比较抗惊厥药加其他药物与其他药物（考虑3项结果），一项研究（72名参与者）的结果支持副醛加氯水合氯比氯氮䓬在严重危及生命的副作用方面更优，RR 0.12（0.03至0.44）。
本综述结果未提供充分证据支持抗惊厥药用于治疗酒精戒断综合征。有一些迹象表明，与目前作为酒精戒断综合征一线治疗方案的苯二氮䓬类药物相比，卡马西平在治疗酒精戒断的某些方面可能实际上更有效。抗惊厥药似乎副作用有限，尽管在分析的试验中不良反应报告并不严格。
