Frank Netter School of Medicine, Quinnipiac University, Hamden, CT.
J Clin Psychopharmacol. 2024;44(3):223-231. doi: 10.1097/JCP.0000000000001849.
Prior studies indicate that neuroactive steroids mediate some of alcohol's effects. Dutasteride, widely used to treat benign prostatic hypertrophy, is an inhibitor of 5-alpha reductase enzymes, which play a central role in the production of 5α-reduced neuroactive steroids. The purpose of this study was to test dutasteride's tolerability and efficacy for reducing drinking.
Men (n = 142) with heavy drinking (>24 drinks per week) and a goal to either stop or reduce drinking to nonhazardous levels were randomized to placebo or 1 mg dutasteride daily for 12 weeks. We hypothesized that dutasteride-treated patients would be more successful in reducing drinking.
Generalized linear mixed models that included baseline drinking, treatment, time and their 2-way interaction identified significant interactions of treatment-time, such that dutasteride treatment reduced drinking more than placebo. During the last month of treatment, 25% of dutasteride-treated participants had no hazardous drinking (no heavy drinking days and not more than 14 drinks per week) compared with 6% of placebo-treated participants (P = 0.006; NNT = 6). Sensitivity analysis identified baseline drinking to cope as a factor associated with larger reductions in drinking for dutasteride compared with placebo-treated participants. Dutasteride was well tolerated. Adverse events more common in the dutasteride group were stomach discomfort and reduced libido.
Dutasteride 1 mg daily was efficacious in reducing the number of heavy drinking days and drinks per week in treatment-seeking men. The benefit of dutasteride compared with placebo was greatest for participants with elevated baseline drinking to cope motives.
先前的研究表明神经活性甾体介导了酒精的部分作用。度他雄胺被广泛用于治疗良性前列腺增生，是 5α-还原酶的抑制剂，该酶在 5α-还原神经活性甾体的产生中起着核心作用。本研究旨在测试度他雄胺对减少饮酒的耐受性和疗效。
有大量饮酒（>24 杯/周）和停止或减少饮酒至非危险水平目标的男性（n=142）被随机分配至安慰剂或 1mg 度他雄胺组，每日一次，共 12 周。我们假设度他雄胺治疗组患者在减少饮酒方面会更成功。
包含基线饮酒量、治疗、时间及其 2 者交互作用的广义线性混合模型确定了治疗时间的显著交互作用，即度他雄胺治疗比安慰剂治疗减少饮酒量更多。在治疗的最后一个月，25%的度他雄胺治疗组参与者没有危险饮酒（没有重度饮酒日，且每周饮酒不超过 14 杯），而安慰剂治疗组参与者为 6%（P=0.006；NNT=6）。敏感性分析确定基线饮酒以应对为与度他雄胺治疗相比，安慰剂治疗组参与者减少饮酒量更大的相关因素。度他雄胺具有良好的耐受性。度他雄胺组更常见的不良反应是胃部不适和性欲降低。
每日 1mg 度他雄胺对减少寻求治疗的男性重度饮酒日数和每周饮酒量有效。与安慰剂相比，度他雄胺的益处对基线饮酒以应对动机升高的参与者最大。
