Litten Raye Z, Falk Daniel E, Ryan Megan L, Fertig Joanne, Leggio Lorenzo
Division of Medications Development, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA.
Section of Clinical Psychoneuroendocrinology and Neuropsychopharmacology, National Institute on Alcohol Abuse and Alcoholism and National Institute on Drug Abuse, Bethesda, MD, USA.
Handb Exp Pharmacol. 2018;248:579-613. doi: 10.1007/164_2017_79.
For more than 25 years, researchers have made advances in developing medications to treat alcohol use disorder (AUD), highlighted by the US Food and Drug Administration's (FDA's) approval of disulfiram, naltrexone (oral and long-acting), and acamprosate. These medications are also approved in Europe, where the European Medicines Agency (EMA) recently added a fourth medication, nalmefene, for AUD. Despite these advances, today's medications have a small effect size, showing efficacy for only a limited number of individuals with AUD. However, a host of new medications, which act on variety of pharmacologic targets, are in the pipeline and have been evaluated in numerous human studies. This article reviews the efficacy and safety of medications currently being tested in human trials and looks at ongoing efforts to identify candidate compounds in human studies. As mentioned in the National Institute on Alcohol Abuse and Alcoholism's Strategic Plan 2017-2021 ( https://www.niaaa.nih.gov/sites/default/files/StrategicPlan_NIAAA_optimized_2017-2020.pdf ), medications development remains a high priority. By developing more effective and safe medications, and identifying those patients who will benefit the most from these treatments, we can provide clinicians with the tools they need to treat this devastating disorder, providing relief for patients and their families and markedly improving public health and safety.
25 多年来,研究人员在开发治疗酒精使用障碍(AUD)的药物方面取得了进展,美国食品药品监督管理局(FDA)批准双硫仑、纳曲酮(口服和长效)和阿坎酸就是突出成果。这些药物在欧洲也获得了批准,欧洲药品管理局(EMA)最近又为 AUD 增加了第四种药物——纳美芬。尽管取得了这些进展,但目前的药物疗效甚微,仅对有限数量的 AUD 患者有效。然而,许多作用于多种药理学靶点的新型药物正在研发中,并已在众多人体研究中得到评估。本文综述了目前正在人体试验中测试的药物的疗效和安全性,并探讨了在人体研究中识别候选化合物的持续努力。正如美国国立酒精滥用与酒精中毒研究所 2017 - 2021 年战略计划(https://www.niaaa.nih.gov/sites/default/files/StrategicPlan_NIAAA_optimized_2017 - 2020.pdf)中所提到的,药物研发仍然是高度优先事项。通过开发更有效、更安全的药物,并确定那些将从这些治疗中受益最大的患者,我们可以为临床医生提供治疗这种毁灭性疾病所需的工具,为患者及其家人带来缓解,并显著改善公众健康和安全。