Maglione Margaret A, Laura Raaen, Christine Chen, Azhar Gulrez Shah, Nima Shahidinia, Mimi Shen, Hernandez Ervant J Maksabedian, Shanman Roberta M, Susanne Hempel
Rand Health Q. 2020 Jun 15;8(4). eCollection 2020 Jun.
This systematic review addresses the question: What are the effects of medication-assisted treatment (MAT) that use buprenorphine, buprenorphine combined with naloxone, methadone, or naltrexone for opioid use disorder (OUD) on functional outcomes compared with wait-list, placebo, treatment without medication, any other comparator, or each other (e.g., buprenorphine versus naltrexone)? Functional outcomes investigated included cognitive (e.g., memory), physical (e.g., fatigue), occupational (e.g., employment status), social/behavioral (e.g., criminal activity), and neurological (e.g., balance) function. The authors searched five scientific research databases from inception to 2017 and reference mined existing reviews. Two independent literature reviewers screened 6,292 citations; 1,327 full-text publications were reviewed in detail and 37 studies met inclusion criteria. Critical appraisals assessed studies in detail, and quality of evidence was rated using established criteria. Results were synthesized in meta-analyses and presented in comprehensive evidence tables. Although MAT patients performed significantly better on some functional outcomes than persons with OUD who did not receive MAT, MAT patients performed worse on several cognitive measures than did matched "healthy" controls with no history of substance use disorder (SUD) or OUD. Because of the moderate-to-high risk of bias of most studies, quality of evidence is low or very low for all findings. The small number of studies reporting on outcomes of interest and the weaknesses in the body of evidence prevent making strong conclusions about MAT effects on functional outcomes. The literature shows that more research is needed that targets functional outcomes specifically, and there is, in particular, a lack of research evaluating potential differences in functional effects among medication types, the route of administration, treatment modality, and length of treatment.
与等候名单、安慰剂、非药物治疗、任何其他对照或相互比较（例如丁丙诺啡与纳曲酮）相比，使用丁丙诺啡、丁丙诺啡联合纳洛酮、美沙酮或纳曲酮进行药物辅助治疗（MAT）对阿片类物质使用障碍（OUD）患者功能结局的影响是什么？所研究的功能结局包括认知功能（如记忆力）、身体功能（如疲劳）、职业功能（如就业状况）、社会/行为功能（如犯罪活动）和神经功能（如平衡）。作者检索了5个科学研究数据库，检索时间跨度从建库至2017年，并对现有综述进行了参考文献挖掘。两名独立的文献 reviewers 筛选了6292条引文；对1327篇全文出版物进行了详细审查，37项研究符合纳入标准。通过批判性评价对研究进行了详细评估，并使用既定标准对证据质量进行了评级。结果在荟萃分析中进行了综合，并呈现于全面的证据表中。尽管MAT患者在某些功能结局上的表现明显优于未接受MAT的OUD患者，但在几项认知指标上，MAT患者的表现比无物质使用障碍（SUD）或OUD病史的匹配“健康”对照更差。由于大多数研究存在中到高的偏倚风险，所有研究结果的证据质量均为低或极低。报告感兴趣结局的研究数量较少以及证据主体存在的缺陷，使得无法就MAT对功能结局的影响得出强有力的结论。文献表明，需要开展更多专门针对功能结局的研究，尤其是缺乏评估不同药物类型、给药途径、治疗方式和治疗时长在功能效应方面潜在差异的研究。
