Department of Emergency Medicine, University of California, San Francisco, CA, USA.
UCSF Health Sciences Library, University of California, San Francisco, CA, USA.
Addiction. 2022 Feb;117(2):271-281. doi: 10.1111/add.15572. Epub 2021 Jun 28.
The aims of this study were to (1) estimate the effect of extended-release naltrexone compared with placebo on alcohol consumption in patients with alcohol use disorder (AUD) and (2) conduct pre-planned subgroup analyses to test whether being abstinent when initiating treatment (lead-in abstinence) or the duration of treatment improves treatment efficacy.
Systematic review and random-effects meta-analysis of blinded randomized placebo-controlled trials reporting the effect extended-release naltrexone on alcohol consumption.
Outpatient clinics.
Seven trials evaluating a total of 1500 adults with AUD receiving monthly injections of either placebo or extended-release naltrexone at doses of 150-400 mg for 2-6 months and some form of behavioral therapy.
Pooled weighted mean difference (WMD) in drinking days per month and heavy drinking days per month.
The WMD was -2.0 [95% confidence interval (CI) = -3.4, -0.6; P = 0.03] in favor of extended-release naltrexone for drinking days per month and -1.2 (95% CI = -0.2, -2.1; P = 0.02) for heavy drinking days per month, indicating that treatment resulted in two fewer drinking days per month and 1.2 fewer heavy drinking days per month compared with placebo. Trials not requiring lead-in abstinence and those lasting longer than 3 months reported larger reductions in heavy drinking days per month; WMD -2.0 (95% CI = -3.52, -0.48; P = 0.01) and -1.9 (95% CI = -3.2, -0.5; P = 0.01), respectively. In all cases, the I statistics (0-7.2%) did not suggest substantial heterogeneity.
Extended-release naltrexone reduces drinking days and heavy drinking days per month compared with placebo. Reductions are larger with a longer duration of treatment.
本研究的目的是：(1) 评估缓释纳曲酮与安慰剂相比对酒精使用障碍 (AUD) 患者饮酒量的影响；(2) 进行预先计划的亚组分析，以测试起始治疗时是否保持禁欲（先导禁欲）或治疗持续时间是否能改善治疗效果。
对报告缓释纳曲酮对酒精消耗影响的双盲随机安慰剂对照试验进行系统评价和随机效应荟萃分析。
门诊诊所。
七项试验共评估了 1500 名患有 AUD 的成年人，他们每月接受安慰剂或剂量为 150-400mg 的缓释纳曲酮注射治疗，持续 2-6 个月，并接受某种形式的行为疗法。
每月饮酒天数和每月重度饮酒天数的合并加权均数差 (WMD)。
缓释纳曲酮组的每月饮酒天数的 WMD 为-2.0（95%置信区间 [CI] = -3.4，-0.6；P = 0.03），每月重度饮酒天数的 WMD 为-1.2（95% CI = -0.2，-2.1；P = 0.02），表明与安慰剂相比，治疗导致每月饮酒天数减少 2 天，每月重度饮酒天数减少 1.2 天。不需要先导禁欲的试验和持续时间超过 3 个月的试验报告每月重度饮酒天数的减少幅度更大；WMD -2.0（95% CI = -3.52，-0.48；P = 0.01）和-1.9（95% CI = -3.2，-0.5；P = 0.01）。在所有情况下，I 统计量（0-7.2%）均表明异质性较小。
与安慰剂相比，缓释纳曲酮可减少每月饮酒天数和重度饮酒天数。治疗持续时间越长，减少幅度越大。
