重度饮酒模式与抑郁严重程度的相互作用预测富马酸喹硫平缓释片在降低酒精使用障碍患者酒精摄入量方面的疗效。
Interaction of Heavy Drinking Patterns and Depression Severity Predicts Efficacy of Quetiapine Fumarate XR in Lowering Alcohol Intake in Alcohol Use Disorder Patients.
作者信息
Vatsalya Vatsalya, Kong Maiying, Marsano Luis M, Kurlawala Zimple, Chandras Kan V, Schwandt Melanie L, Ramchandani Vijay A, McClain Craig J
机构信息
Department of Medicine, University of Louisville, Louisville, KY, USA.
Robley Rex VA Medical Center, Louisville, KY, USA.
出版信息
Subst Abuse. 2020 Sep 9;14:1178221820955185. doi: 10.1177/1178221820955185. eCollection 2020.
BACKGROUND
Shared etiological pathways of dopamine and serotonin neurotransmission play a central role in heavy alcohol intake and exacerbation in the symptoms of depression.We investigated the treatment efficacy of Quetiapine fumarate extended release (XR) in lowering alcohol intake in alcohol use disorder (AUD) patients indicated by the shared alleviation of depression ratings and patterns of heavy drinking.
METHODS
Hundred and eight male and female heavy drinking AUD patients in the age range of 18 to 64 years. participated in a randomized clinical trial (RCT) to receive 12 weeks of quetiapine XR or placebo (N = 115). Participants were sub-grouped by the severity grading of depression using Montgomery-Asberg Depression Rating Scale (MADRS) (clinically relevant ⩾8 [CR], clinically non-relevant ⩽7 [CNR]) at baseline in both the groups. Drinking history and depression ratings were assessed at the patients' visits.
RESULTS
Heavy drinking days (HDD) and total drinks (TD) were significantly fewer in CR patients at the treatment end. A true positive response in AUROC analysis supported the lowering of TD in CR patients. The number of drinking days (NDD) and average drinks per drinking day (AvgD) were lower in the CNR patients at treatment-end. Significant associations with increasing effect sizes were observed for all the heavy drinking measures (HDD, TD, NDD, and AvgD) and MADRS scores by the end of the treatment course.
CONCLUSIONS
Baseline elevated depressive symptoms could likely predict the course of heavy alcohol drinking during the treatment, and efficacy outcome of a treatment. AUD patients with baseline clinically significant depression had a progressive lowering in heavy drinking markers significantly corresponding to the lowering of depression symptoms by the end of treatment with Quetiapine fumarate XR.ClinicalTrials.gov: NCT#0049862 (https://clinicaltrials.gov/ct2/show/NCT00498628?term=litten&draw=2&rank=3).
背景
多巴胺和5-羟色胺神经传递的共同病因途径在大量饮酒和抑郁症症状加重中起核心作用。我们通过共享的抑郁评分缓解和大量饮酒模式改善，研究了富马酸喹硫平缓释片（XR）降低酒精使用障碍（AUD）患者酒精摄入量的治疗效果。
方法
108名年龄在18至64岁之间的男性和女性重度饮酒AUD患者参与了一项随机临床试验（RCT），接受为期12周的喹硫平XR或安慰剂治疗（N = 115）。两组患者在基线时均使用蒙哥马利-阿斯伯格抑郁评定量表（MADRS）按抑郁严重程度分级进行亚组划分（临床相关≥8 [CR]，临床不相关≤7 [CNR]）。在患者就诊时评估饮酒史和抑郁评分。
结果
治疗结束时，CR组患者的重度饮酒天数（HDD）和总饮酒量（TD）显著减少。AUROC分析中的真阳性反应支持CR组患者TD的降低。治疗结束时，CNR组患者的饮酒天数（NDD）和平均每日饮酒量（AvgD）较低。在治疗过程结束时，所有重度饮酒指标（HDD、TD、NDD和AvgD）与MADRS评分之间均观察到与效应大小增加的显著关联。
结论
基线时抑郁症状升高可能预测治疗期间大量饮酒的进程以及治疗效果。基线时有临床显著抑郁的AUD患者在接受富马酸喹硫平XR治疗结束时，重度饮酒指标逐渐降低，且与抑郁症状的减轻显著相关。ClinicalTrials.gov：NCT#0049862（https://clinicaltrials.gov/ct2/show/NCT00498628?term=litten&draw=2&rank=3）。
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