Thompson Andrew, Ashcroft Darren M, Owens Lynn, van Staa Tjeerd P, Pirmohamed Munir
Wolfson Centre for Personalised Medicine, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom.
Centre for Pharmacoepidemiology and Drug Safety, University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, United Kingdom.
PLoS One. 2017 Mar 20;12(3):e0173272. doi: 10.1371/journal.pone.0173272. eCollection 2017.
To evaluate drug therapy for alcohol dependence in the 12 months after first diagnosis in UK primary care.
Open cohort study.
General practices contributing data to the UK Clinical Practice Research Database.
39,980 people with an incident diagnosis of alcohol dependence aged 16 years or older between 1 January 1990 and 31 December 2013.
Use of pharmacotherapy (acamprosate, disulfiram, naltrexone, baclofen and topiramate) to promote abstinence from alcohol or reduce drinking to safe levels in the first 12 months after a recorded diagnosis of alcohol dependence.
Only 4,677 (11.7%) of the cohort received relevant pharmacotherapy in the 12 months following diagnosis. Of the 35,303 that did not receive pharmacotherapy, 3,255 (9.2%) received psychosocial support. The remaining 32,048 (80.2%) did not receive either mode of treatment in the first 12 months. Factors that independently reduced the likelihood of receiving pharmacotherapy included: being male (Odds Ratio [OR] 0.74; 95% CI 0.69 to 0.78); older (65-74 years: OR 0.61; 95% CI 0.49 to 0.77); being from a practice based in the most deprived quintile (OR 0.58; 95% CI 0.53 to 0.64); and being located in Northern Ireland (OR 0.78; 95% CI 0.67 to 0.91). The median duration to initiation of pharmacotherapy was 0.80 months (95% CI 0.70 to 1.00) for acamprosate and 0.60 months (95% CI 0.43 to 0.73) for disulfiram. Persistence analysis for those receiving acamprosate and disulfiram revealed that many patients never received a repeat prescription; persistence at 6 months was 27.7% for acomprosate and 33.2% for disulfiram. The median duration of therapy was 2.10 months (95% CI 1.87 to 2.53) for acamprosate and 3.13 months (95% CI 2.77 to 3.36) for disulfiram.
Drug therapy to promote abstinence in alcohol dependent patients was low, with the majority of patients receiving no therapy, either psychological or pharmacological. When drug therapy was prescribed, persistence was low with most patients receiving only one prescription. Our data show that treatment for alcohol dependence is haphazard, and there is an urgent need to explore strategies for improving clinical management of this patient group.
评估英国初级医疗中首次诊断酒精依赖后12个月内的药物治疗情况。
开放队列研究。
向英国临床实践研究数据库提供数据的全科医疗诊所。
1990年1月1日至2013年12月31日期间，39980名年龄在16岁及以上的酒精依赖初诊患者。
在记录诊断酒精依赖后的前12个月内，使用药物治疗（阿坎酸、双硫仑、纳曲酮、巴氯芬和托吡酯）促进戒酒或将饮酒量降至安全水平。
队列中仅有4677人（11.7%）在诊断后的12个月内接受了相关药物治疗。在未接受药物治疗的35303人中，3255人（9.2%）接受了心理社会支持。其余32048人（80.2%）在最初的12个月内未接受任何一种治疗方式。独立降低接受药物治疗可能性的因素包括：男性（比值比[OR]0.74；95%置信区间0.69至0.78）；年龄较大（65 - 74岁：OR 0.61；95%置信区间0.49至0.77）；来自最贫困五分之一地区的诊所（OR 0.58；95%置信区间0.53至0.64）；以及位于北爱尔兰（OR 0.78；95%置信区间0.67至0.9）。阿坎酸开始药物治疗的中位时间为0.80个月（95%置信区间0.70至1.00），双硫仑为0.60个月（95%置信区间0.43至0.73）。对接受阿坎酸和双硫仑治疗患者的持续性分析显示，许多患者从未获得重复处方；阿坎酸6个月时的持续性为27.7%，双硫仑为33.2%。阿坎酸治疗的中位持续时间为2.10个月（95%置信区间1.87至2.53），双硫仑为3.13个月（95%置信区间2.77至3.36）。
促进酒精依赖患者戒酒的药物治疗率较低，大多数患者未接受心理或药物治疗。当开具药物治疗处方时，持续性较低，大多数患者仅接受一次处方。我们的数据表明，酒精依赖的治疗是随意的，迫切需要探索改善该患者群体临床管理的策略。
