Paille François
Département d'addictologie Centre psychothérapique de Laxou, Laxou, France.
Rev Prat. 2019 Oct;69(8):909-916.
Medical management of alcohol use disorders. Psychosocial support remains the key element of treatment of patients with an alcohol use disorder in order to either decrease or cease their alcohol consumption. However two drugs can now be used to reduce alcohol consumption: nalmefene and baclofen. Currently available studies have shown weak to moderate effect sizes in this indication. Four molecules are available to help patients maintain abstinence: acamprosate, naltrexone, disulfiram and baclofen (off-label use). Effect sizes calculated by various metaanalyses are also low to moderate. Disulfiram appears to be more effective when the patient has understood its mechanism of action and when it is used under supervision. However, the use of disulfiram is limited by the risk of rare, but potentially serious adverse effects. Identification of patient subgroups obtaining better responses to certain drugs constitutes a major research challenge, but only a few criteria have been defined to date. However, regardless of the drug considered, heavy drinking and difficulty to maintain abstinence significantly improve the efficacy of the drugs. After an initially promising period, identification of genetic markers has not yet resulted in any clinical applications. Promising molecules currently under evaluation include sodium oxybate and topiramate.
酒精使用障碍的药物治疗。心理社会支持仍然是酒精使用障碍患者治疗的关键要素，目的是减少或停止他们的酒精消费。然而，现在有两种药物可用于减少酒精消费：纳美芬和巴氯芬。目前可得的研究表明在这一适应症中效应大小为弱到中等。有四种药物可帮助患者保持戒酒状态：阿坎酸、纳曲酮、双硫仑和巴氯芬（非适应症用药）。各种荟萃分析计算出的效应大小也为低到中等。当患者理解双硫仑的作用机制并在监督下使用时，双硫仑似乎更有效。然而，双硫仑的使用受到罕见但可能严重的不良反应风险的限制。确定对某些药物反应更好的患者亚组是一项重大研究挑战，但迄今为止仅定义了少数标准。然而，无论考虑使用哪种药物，大量饮酒和难以保持戒酒状态都能显著提高药物疗效。在经历了最初充满希望的阶段后，基因标志物的识别尚未产生任何临床应用。目前正在评估的有前景的药物包括γ-羟丁酸钠和托吡酯。
