Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
Department of Basic Psychology and Methodology, University of Murcia, Spain.
BMJ. 2020 Nov 25;371:m3934. doi: 10.1136/bmj.m3934.
To determine the most effective interventions in recently detoxified, alcohol dependent patients for implementation in primary care.
Systematic review and network meta-analysis.
Medline, Embase, PsycINFO, Cochrane CENTRAL, ClinicalTrials.gov, and the World Health Organization's International Clinical Trials Registry Platform.
Randomised controlled trials comparing two or more interventions that could be used in primary care. The population was patients with alcohol dependency diagnosed by standardised clinical tools and who became detoxified within four weeks.
Outcomes of interest were continuous abstinence from alcohol (effectiveness) and all cause dropouts (as a proxy for acceptability) at least 12 weeks after start of intervention.
64 trials (43 interventions) were included. The median probability of abstinence across placebo arms was 25%. Compared with placebo, the only intervention associated with increased probability of abstinence and moderate certainty evidence was acamprosate (odds ratio 1.86, 95% confidence interval 1.49 to 2.33, corresponding to an absolute probability of 38%). Of the 62 included trials that reported all cause dropouts, interventions associated with a reduced number of dropouts compared with placebo (probability 50%) and moderate certainty of evidence were acamprosate (0.73, 0.62 to 0.86; 42%), naltrexone (0.70, 0.50 to 0.98; 41%), and acamprosate-naltrexone (0.30, 0.13 to 0.67; 17%). Acamprosate was the only intervention associated with moderate confidence in the evidence of effectiveness and acceptability up to 12 months. It is uncertain whether other interventions can help maintain abstinence and reduce dropouts because of low confidence in the evidence.
Evidence is lacking for benefit from interventions that could be implemented in primary care settings for alcohol abstinence, other than for acamprosate. More evidence from high quality randomised controlled trials is needed, as are strategies using combined interventions (combinations of drug interventions or drug and psychosocial interventions) to improve treatment of alcohol dependency in primary care.
PROSPERO CRD42016049779.
确定在最近戒断且依赖酒精的患者中，用于初级保健的最有效干预措施。
系统评价和网络荟萃分析。
Medline、Embase、PsycINFO、Cochrane 中心、ClinicalTrials.gov 和世界卫生组织国际临床试验注册平台。
比较两种或多种可在初级保健中使用的干预措施的随机对照试验。该人群为通过标准化临床工具诊断为酒精依赖且在四周内戒断的患者。
感兴趣的结局是干预开始至少 12 周后持续戒酒（有效性）和全因脱落（作为可接受性的替代指标）。
纳入了 64 项试验（43 项干预措施）。安慰剂组的戒酒中位数概率为 25%。与安慰剂相比，唯一与增加戒酒概率相关且具有中等确定性证据的干预措施是安考酮（优势比 1.86，95%置信区间 1.49 至 2.33，对应的绝对概率为 38%）。在 62 项报告全因脱落的纳入试验中，与安慰剂相比，减少脱落人数的干预措施（概率为 50%）和具有中等确定性证据的干预措施是安考酮（0.73，0.62 至 0.86；42%）、纳曲酮（0.70，0.50 至 0.98；41%）和安考酮-纳曲酮（0.30，0.13 至 0.67；17%）。安考酮是唯一一种在 12 个月内具有有效性和可接受性中等置信度证据的干预措施。由于证据可信度低，尚不确定其他干预措施是否有助于保持戒酒和减少脱落。
除安考酮外，在初级保健环境中实施的能够促进戒酒的干预措施，其获益证据不足。需要更多来自高质量随机对照试验的证据，以及使用联合干预措施（药物干预或药物与心理社会干预相结合）的策略，以改善初级保健中的酒精依赖治疗。
PROSPERO CRD42016049779。
Zotero 插件
