Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland.
Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden.
Addiction. 2021 Aug;116(8):1990-1998. doi: 10.1111/add.15384. Epub 2021 Jan 14.
Pharmacotherapy for alcohol use disorder (AUD) is recommendable, but under-used, possibly due to deficient knowledge of medications. This study aimed to investigate the real-world effectiveness of approved pharmacological treatments (disulfiram, acamprosate, naltrexone and nalmefene) of AUD.
A nation-wide, register-based cohort study.
Sweden.
All residents aged 16-64 years living in Sweden with registered first-time treatment contact due to AUD from July 2006 to December 2016 (n = 125 556, 62.5% men) were identified from nation-wide registers.
The main outcome was hospitalization due to AUD. The secondary outcomes were hospitalization due to any cause, alcohol-related somatic causes, as well as work disability (sickness absence or disability pension), and death. Mortality was analysed with between-individual analysis using a traditional multivariate-adjusted Cox hazards regression model. Recurrent outcomes, such as hospitalization-based events and work disability, were analysed with within-individual analyses to eliminate selection bias.
Naltrexone combined with acamprosate [hazard ratio (HR) = 0.74; 95% confidence interval (CI) = 0.61-0.89], combined with disulfiram (HR = 0.76, 95% CI = 0.60-0.96) and as monotherapy (HR = 0.89, 95% CI = 0.81-0.97) was associated with a significantly lower risk of AUD-hospitalization compared with no use of AUD medication. Similar results were found for risk of hospitalization due to any cause. Benzodiazepine use and acamprosate monotherapy were associated with an increased risk of AUD-hospitalization (HR = 1.18, 95% CI = 1.14-1.22 and HR = 1.10, 95% CI = 1.04-1.17, respectively). No statistically significant effects were found for work disability or mortality.
Naltrexone as monotherapy and when combined with disulfiram and acamprosate appears to be associated with lower risk of hospitalization due to any and alcohol-related causes, compared with no use of alcohol use disorder (AUD) medication. Acamprosate monotherapy and benzodiazepine use appear to be associated with increased risk of AUD-associated hospitalization.
酒精使用障碍（AUD）的药物治疗是值得推荐的，但实际应用不足，这可能是由于对药物的了解不足。本研究旨在调查已批准的 AUD 药物（双硫仑、安非他酮、纳曲酮和纳美芬）的真实世界疗效。
一项全国范围内基于登记的队列研究。
瑞典。
所有年龄在 16-64 岁之间的瑞典居民，2006 年 7 月至 2016 年 12 月期间首次因 AUD 在全国范围内的登记处登记治疗（n=125556，62.5%为男性）。
主要结局是因 AUD 住院。次要结局是因任何原因住院、与酒精相关的躯体原因、工作残疾（病假或残疾抚恤金）和死亡。使用传统的多变量调整 Cox 风险回归模型对死亡率进行个体间分析。使用个体内分析分析复发性结局，如基于住院的事件和工作残疾，以消除选择偏差。
与未使用 AUD 药物相比，纳曲酮联合安非他酮（风险比[HR]0.74；95%置信区间[CI]0.61-0.89）、联合双硫仑（HR0.76，95%CI0.60-0.96）和单药治疗（HR0.89，95%CI0.81-0.97）与 AUD 住院风险显著降低相关。对于任何原因导致的住院风险也得到了类似的结果。苯二氮䓬类药物的使用和安非他酮单药治疗与 AUD 住院风险增加相关（HR1.18，95%CI1.14-1.22 和 HR1.10，95%CI1.04-1.17）。未发现工作残疾或死亡率有统计学意义的影响。
与未使用酒精使用障碍（AUD）药物相比，纳曲酮单药治疗以及与双硫仑和安非他酮联合治疗似乎与任何原因和酒精相关原因导致的住院风险降低相关。安非他酮单药治疗和苯二氮䓬类药物的使用与 AUD 相关住院风险增加相关。
