COMBINE 研究中，使用安非他酮和纳曲酮适度饮酒的基准轨迹。
Baseline trajectories of drinking moderate acamprosate and naltrexone effects in the COMBINE study.
机构信息
Yale University School of Public Health and School of Medicine, New Haven, Connecticut, USA.
出版信息
Alcohol Clin Exp Res. 2011 Mar;35(3):523-31. doi: 10.1111/j.1530-0277.2010.01369.x. Epub 2010 Dec 8.
BACKGROUND
The COMBINE study evaluated the effects of acamprosate, naltrexone, and the Combined Behavioral Intervention (CBI). In secondary analyses, our goals were to identify trajectories of any drinking prior to randomization, to characterize subjects in these trajectories, and to assess whether prerandomization trajectories predict drinking outcomes and moderate treatment response.
METHODS
We analyzed daily indicators of any drinking in 90 days prior to randomization using a trajectory-based approach. General linear models and generalized logistic regression assessed main and interactive effects of prerandomization drinking trajectories and treatment on summary drinking measures during active treatment.
RESULTS
We identified five trajectories of any drinking prior to randomization: "T1: frequent drinkers", "T2: very frequent drinkers", "T3: nearly daily drinkers", "T4: consistent daily drinkers", and "T5: daily drinkers stopping early". During treatment, "T3: nearly daily drinkers" and "T4: consistent daily drinkers" had significantly worse drinking outcomes than "T1: frequent drinkers", while "T5: daily drinkers stopping early" had comparable drinking outcomes to "T1: frequent drinkers". Acamprosate significantly increased the chance of abstinence from heavy drinking for the "T2: very frequent drinking" trajectory but decreased the chance of abstinence from heavy drinking for "T5: daily drinkers stopping early". Naltrexone differentially improved rates of continuous abstinence for very frequent drinkers.
CONCLUSIONS
Acamprosate benefited very frequent drinkers and contrary to expectations was associated with poorer response compared to placebo for consistent daily drinkers who had longer durations of pretreatment abstinence (e.g., ≥14 days). Baseline drinking trajectories also moderated naltrexone effects. These findings may help clinicians identify patients for whom acamprosate and naltrexone may be most beneficial.
背景
COMBINE 研究评估了安非他酮、纳曲酮和联合行为干预（CBI）的效果。在二次分析中，我们的目标是确定随机分组前任何饮酒的轨迹，描述这些轨迹中的受试者特征，并评估随机分组前轨迹是否预测饮酒结局和治疗反应的调节作用。
方法
我们使用基于轨迹的方法分析了随机分组前 90 天内的任何饮酒的每日指标。采用一般线性模型和广义逻辑回归评估了随机分组前饮酒轨迹和治疗对治疗期间综合饮酒指标的主要和交互作用。
结果
我们确定了随机分组前任何饮酒的五种轨迹：“T1：频繁饮酒者”、“T2：非常频繁饮酒者”、“T3：几乎每天饮酒者”、“T4：持续每天饮酒者”和“T5：早期每天饮酒者停止饮酒者”。在治疗期间，“T3：几乎每天饮酒者”和“T4：持续每天饮酒者”的饮酒结局明显比“T1：频繁饮酒者”差，而“T5：早期每天饮酒者停止饮酒者”的饮酒结局与“T1：频繁饮酒者”相当。安非他酮显著增加了“T2：非常频繁饮酒者”轨迹中停止重度饮酒的机会，但降低了“T5：早期每天饮酒者停止饮酒者”轨迹中停止重度饮酒的机会。纳曲酮显著改善了非常频繁饮酒者连续戒酒的比率。
结论
安非他酮有益于非常频繁饮酒者，与预期相反，与安慰剂相比，对持续每天饮酒者的反应较差，这些患者在治疗前有较长时间的戒酒（例如，≥14 天）。基线饮酒轨迹也调节了纳曲酮的效果。这些发现可能有助于临床医生识别出最适合使用安非他酮和纳曲酮的患者。
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