苯二氮䓬类药物和 Z 类药物减量的可行性和有效性：系统评价和荟萃分析。
Feasibility and effectiveness of deprescribing benzodiazepines and Z-drugs: systematic review and meta-analysis.
机构信息
London School of Hygiene and Tropical Medicine, London, UK.
Academy of Primary Care, Hull York Medical School, Hull, UK.
出版信息
Addiction. 2023 Jan;118(1):7-16. doi: 10.1111/add.15997. Epub 2022 Jul 24.
BACKGROUND AND AIMS
A total of 2.4 million adults in England were dispensed a benzodiazepine or Z-drug (BZRA) in 2017/18, and more than 250 000 patients in the UK take BZRAs beyond the recommended duration. Deprescribing is a clinician-guided process of withdrawing inappropriate drugs. This review aimed to evaluate the evidence base supporting the feasibility and clinical effectiveness of all forms of deprescribing initiatives used to discontinue long-term (≥ 4 weeks) BZRAs.
METHOD
Systematic review of randomized controlled trials evaluating BZRAs deprescribing among adults in community, primary or outpatient settings. MEDLINE, Embase and PsycINFO were searched from inception to February 2021. Primary outcomes were successful discontinuation in the short (< 4 weeks) or long term (≥ 4 weeks) and the occurrence of withdrawal symptoms, behavioural or psychological symptoms. Studies were categorized as pharmacological or non-pharmacological supported interventions. Study quality was assessed using the Cochrane risk-of-bias tool. Where appropriate, risk ratios (RRs), mean differences and 95% confidence intervals (CIs) were calculated, and Mantel-Haenszel methods using the random-effect meta-analysis was undertaken to calculate summary effect estimates.
RESULTS
Ten studies were included (n = 1431 participants). Heterogeneity in study design and effect was observed. Benzodiazepines were successfully deprescribed when gradually tapered with non-pharmacological support compared with gradual tapering alone in the short term (n = 124; RR = 2.02; 95% CI = 1.41, 2.89) and long term (n = 123; RR = 2.45; 95% CI = 1.56, 3.85). Benzodiazepine deprescribing was more successful when supported by non-pharmacological methods versus routine care (n = 189; RR = 3.26; 95% CI = 2.36, 4.51). Quality of evidence reporting effectiveness was very low to low.
CONCLUSIONS
It may be feasible to deprescribe benzodiazepines depending on the process and support mechanisms employed.
背景和目的
2017/18 年，英格兰共有 240 万成年人被开具苯二氮䓬类药物或 Z 类药物（BZRA），超过 25 万英国患者服用 BZRA 的时间超过了推荐的时长。减药是一种由临床医生指导的停止使用不适当药物的过程。本综述旨在评估支持所有形式的减药方案用于停止长期（≥4 周）苯二氮䓬类药物使用的可行性和临床有效性的证据基础。
方法
对社区、初级或门诊环境中成年人使用苯二氮䓬类药物减药的随机对照试验进行系统综述。从建库至 2021 年 2 月，检索 MEDLINE、Embase 和 PsycINFO。主要结局是在短期（<4 周）和长期（≥4 周）成功停药以及出现戒断症状、行为或心理症状的情况。研究分为药理学或非药理学支持干预。使用 Cochrane 偏倚风险工具评估研究质量。在适当的情况下，计算风险比（RR）、均数差值和 95%置信区间（CI），并使用随机效应荟萃分析的 Mantel-Haenszel 方法计算汇总效应估计值。
结果
纳入了 10 项研究（n=1431 名参与者）。研究设计和效应存在异质性。与单纯逐渐减量相比，在短期（n=124；RR=2.02；95%CI=1.41，2.89）和长期（n=123；RR=2.45；95%CI=1.56，3.85），在非药理学支持下逐渐减量可更成功地停用苯二氮䓬类药物。与常规护理相比，在非药理学方法的支持下，苯二氮䓬类药物的减药更为成功（n=189；RR=3.26；95%CI=2.36，4.51）。报告有效性的证据质量为极低到低。
结论
根据所采用的流程和支持机制，停用苯二氮䓬类药物可能是可行的。
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