Cuocina Micol, Aiello Giuseppe, Cutrufelli Pierfelice, Rampello Martina, Rapisarda Laura, Rodolico Alessandro, Cantarella Giuseppina, Signorelli Maria Salvina, Bernardini Renato
Department Biomedical and Biotechnological Sciences (BIOMETEC), Section of Pharmacology, University of Catania, Catania, Italy.
Clinical Toxicology Unit, University Hospital of Catania, Catania, Italy.
Front Pharmacol. 2024 Sep 6;15:1462612. doi: 10.3389/fphar.2024.1462612. eCollection 2024.
N-acetyl cysteine (NAC) appears promising as a treatment in patients with substance use disorder (SUD) as it helps rebalance glutamate levels in the central nervous system (CNS). Basal concentrations of glutamate are indeed reduced in SUD patients but increased during craving.
We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs). We assessed whether NAC reduce craving rating as compared to a placebo in SUD patients. Secondary outcomes were withdrawal symptoms (WS), side effects (SE) and drop-outs. Estimates are presented as standardized mean differences (SMD) or risk ratio (RR) with 95% confidence interval (CI).
Eleven RCTs were included. NAC reduced craving rating (SMD -0.61 (-1.17, -0.06), = 0.03, I2 = 85%), with no differences in the subgroup analysis according to the drug addiction (alcohol, cocaine, poly-drugs, amphetamine, nicotine) ( = 0.98). Among the secondary outcomes, for WS data showed no significant difference between groups (SMD -0.18 (-0.43, 0.08), = 0.17); for SE no substantial difference was observed between the two treatment groups (RR = 1.06 (0.89-1.27), = 0.52, I2 = 0%); for dropouts the results are in favor of the placebo but no statistically significant (RR 1.17 (0.85, 1.61), = 0.34; I2 = 0%).
NAC seem to reduce craving rating in SUD patients, but evidence is weak. More studies are needed to confirm this finding.
N-乙酰半胱氨酸（NAC）作为物质使用障碍（SUD）患者的一种治疗方法似乎很有前景，因为它有助于重新平衡中枢神经系统（CNS）中的谷氨酸水平。事实上，SUD患者的谷氨酸基础浓度降低，但在渴望期间会升高。
我们对随机对照试验（RCT）进行了系统评价和荟萃分析。我们评估了与安慰剂相比，NAC是否能降低SUD患者的渴望评分。次要结局包括戒断症状（WS）、副作用（SE）和退出率。估计值以标准化均数差（SMD）或风险比（RR）及95%置信区间（CI）表示。
纳入了11项RCT。NAC降低了渴望评分（SMD -0.61（-1.17，-0.06），P = 0.03，I² = 85%），根据药物成瘾类型（酒精、可卡因、多种药物、苯丙胺、尼古丁）进行的亚组分析无差异（P = 0.98）。在次要结局中，对于WS，两组数据无显著差异（SMD -0.18（-0.43，0.08），P = 0.17）；对于SE，两个治疗组之间未观察到实质性差异（RR = 1.06（0.89 - 1.27），P = 0.52，I² = 0%）；对于退出率，结果有利于安慰剂，但无统计学意义（RR 1.17（0.85，1.61），P = 0.34；I² = 0%）。
NAC似乎能降低SUD患者的渴望评分，但证据不足。需要更多研究来证实这一发现。
