Brandt Jaden, Bressi Jolene, Lê Mê-Linh, Neal Dejanee, Cadogan Cathal, Witt-Doerring Josef, Witt-Doerring Marissa, Wright Steven
Alliance for Benzodiazepine Best Practices, Portland, OR, USA.
College of Pharmacy, University of Manitoba, Winnipeg, MB, Canada.
EClinicalMedicine. 2024 Mar 13;70:102507. doi: 10.1016/j.eclinm.2024.102507. eCollection 2024 Apr.
Clinical practice guidelines and guidance documents routinely offer prescribing clinicians' recommendations and instruction on the use of psychotropic drugs for mental illness. We sought to characterise parameters relevant to prescribing and deprescribing of benzodiazepine (BZD) and benzodiazepine receptor agonist (BZRA), in clinical practice guidelines and guidance documents internationally, for adult patients with unipolar depression, anxiety disorders and insomnia to understand similarities and discrepancies between evidence-based expert opinion.
A Scoping Review was conducted to characterize documents that offered evidence-based and/or consensus pharmacologic guidance on the management of unipolar depression, anxiety disorders, obsessive-compulsive disorders, post-traumatic stress disorders and insomnia. A systematic search was conducted of PubMed, SCOPUS, PsycINFO and CINAHL from inception to October 13, 2023 and supplemented by a gray literature search. Documents were screened in Covidence for eligibility. Subsequent data-charting on eligible documents collected information on aspects of both prescribing and deprescribing.
113 documents offering guidance on BZD/BZRA use were data-charted. Overall, documents gathered were from Asia (n = 11), Europe (n = 34), North America (n = 37), Oceania (n = 7), and South America (n = 4) with the remainder being "International" (n = 20) and not representative to any particular region or country. By condition the documents reviewed covered unipolar depressive disorders (n = 28), anxiety disorders, obsessive-compulsive disorder and post-traumatic stress disorder (n = 42) and Insomnia (n = 25). Few documents (n = 18) were sufficiently specific and complete to consider as de-prescribing focused documents.
Documents were in concordance in terms of BZD and BZRA not being used routinely as first-line pharmacologic agents. When used, it is advisable to restrict their duration to "short-term" use with the most commonly recommended duration being less than four weeks. Documents were less consistent in terms of prescriptive recommendations for specific drug, dosing and administration pattern (i.e regular or 'as needed') selection for each condition. Deprescribing documents were unanimously in favor of gradual dose reduction and patient shared decision-making. However, approaches towards dose-tapering differed substantially. Finally, there were inconsistencies and/or insufficiency of detail, among deprescribing documents, in terms of switching to a long-acting BZD, use of adjunctive pharmacotherapies and micro-tapering.
The authors received no funding for this work.
临床实践指南和指导文件通常会为开具处方的临床医生提供关于使用精神药物治疗精神疾病的建议和指导。我们试图在国际临床实践指南和指导文件中，确定与苯二氮䓬类药物（BZD）和苯二氮䓬受体激动剂（BZRA）的处方开具和减药相关的参数，用于患有单相抑郁症、焦虑症和失眠症的成年患者，以了解循证专家意见之间的异同。
进行了一项范围综述，以确定那些为单相抑郁症、焦虑症、强迫症、创伤后应激障碍和失眠症的管理提供循证和/或共识性药物治疗指导的文件。从创刊至2023年10月13日，在PubMed、SCOPUS、PsycINFO和CINAHL上进行了系统检索，并辅以灰色文献检索。在Covidence中对文件进行筛选以确定其是否符合资格。随后对符合资格的文件进行数据图表分析，收集关于处方开具和减药方面的信息。
对113份提供BZD/BZRA使用指导的文件进行了数据图表分析。总体而言，收集到的文件来自亚洲（n = 11）、欧洲（n = 34）、北美洲（n = 37）、大洋洲（n = 7）和南美洲（n = 4），其余为“国际”（n = 20）文件，不代表任何特定地区或国家。按疾病类型划分，所审查的文件涵盖单相抑郁障碍（n = 28）、焦虑症、强迫症和创伤后应激障碍（n = 42）以及失眠症（n = 25）。很少有文件（n = 18）足够具体和完整，可以被视为以减药为重点的文件。
在BZD和BZRA不常规用作一线药物这方面，文件观点一致。使用时，建议将其使用期限限制为“短期”，最常推荐的期限少于四周。在针对每种疾病的具体药物、剂量和给药方式（即常规或“按需”）选择的处方建议方面，文件的一致性较差。减药文件一致支持逐渐减量和患者共同决策。然而，减量方法差异很大。最后，在减药文件中，关于换用长效BZD、使用辅助药物治疗和微减量方面，存在不一致和/或细节不足的情况。
作者未获得此项工作的资金支持。
