美国北卡罗来纳大学Melissa McPheeters等研究人员完成酒精使用障碍药物疗法的系统回顾和元分析。相关论文发表在2023年11月7日出版的《美国医学会杂志》上。

为了比较酒精使用障碍疗法的疗效和比较疗效，研究人员对PubMed、Cochrane图书馆、Cochrane中央试验注册中心、PsycINFO、CINAHL和EMBASE进行了检索，随后对从2012年11月到2022年9月9日的文献进行了系统监测，以确定截至2023年8月14日的相关文章，并于 2023年8月14日更新了 PubMed 的检索。

研究人员纳入了118项临床试验和20976名参与者的数据。阿坎酸和口服纳曲酮的治疗所需人数分别为11人（95%CI，1-32人）和18人（95%CI，4-32人），阿坎酸和口服纳曲酮的剂量分别为50毫克/天和50毫克/天。与安慰剂相比，口服纳曲酮（50 毫克/天）可降低重度酗酒率，治疗需要量为11（95%CI，5-41）。在30天的治疗期内，注射纳曲酮与减少酗酒天数有关（加权平均差，-4.99天；95%CI，-9.49 至-0.49 天）。 与安慰剂相比，阿坎酸（腹泻：风险比为1.58；95%CI，1.27-1.97）和纳曲酮（恶心：风险比为1.73；95%CI，1.51-1.98；呕吐：风险比为1.53；95%CI，1.23-1.91）的不良反应包括较高的胃肠道不适。这些研究结果支持将纳曲酮口服液（50毫克/天）和阿坎酸作为治疗酒精使用障碍的一线药物疗法。

据介绍，在美国，超过 2830万人受到酒精使用障碍的影响，发病率和死亡率也随之上升。

附：英文原文

Title: Pharmacotherapy for Alcohol Use Disorder: A Systematic Review and Meta-Analysis

Author: Melissa McPheeters, Elizabeth A. O’Connor, Sean Riley, Sara M. Kennedy, Christiane Voisin, Kaitlin Kuznacic, Cory P. Coffey, Mark D. Edlund, Georgiy Bobashev, Daniel E. Jonas

Issue&Volume: 2023/11/07

Abstract: Importance  Alcohol use disorder affects more than 28.3 million people in the United States and is associated with increased rates of morbidity and mortality.

Objective  To compare efficacy and comparative efficacy of therapies for alcohol use disorder.

Data Sources  PubMed, the Cochrane Library, the Cochrane Central Trials Registry, PsycINFO, CINAHL, and EMBASE were searched from November 2012 to September 9, 2022 Literature was subsequently systematically monitored to identify relevant articles up to August 14, 2023, and the PubMed search was updated on August 14, 2023.

Study Selection  For efficacy outcomes, randomized clinical trials of at least 12 weeks’ duration were included. For adverse effects, randomized clinical trials and prospective cohort studies that compared drug therapies and reported health outcomes or harms were included.

Data Extraction and Synthesis  Two reviewers evaluated each study, assessed risk of bias, and graded strength of evidence. Meta-analyses used random-effects models. Numbers needed to treat were calculated for medications with at least moderate strength of evidence for benefit.

Main Outcomes and Measures  The primary outcome was alcohol consumption. Secondary outcomes were motor vehicle crashes, injuries, quality of life, function, mortality, and harms.

Results  Data from 118 clinical trials and 20976 participants were included. The numbers needed to treat to prevent 1 person from returning to any drinking were 11 (95% CI, 1-32) for acamprosate and 18 (95% CI, 4-32) for oral naltrexone at a dose of 50 mg/d. Compared with placebo, oral naltrexone (50 mg/d) was associated with lower rates of return to heavy drinking, with a number needed to treat of 11 (95% CI, 5-41). Injectable naltrexone was associated with fewer drinking days over the 30-day treatment period (weighted mean difference, 4.99 days; 95% CI, 9.49 to 0.49 days) Adverse effects included higher gastrointestinal distress for acamprosate (diarrhea: risk ratio, 1.58; 95% CI, 1.27-1.97) and naltrexone (nausea: risk ratio, 1.73; 95% CI, 1.51-1.98; vomiting: risk ratio, 1.53; 95% CI, 1.23-1.91) compared with placebo.

Conclusions and Relevance  In conjunction with psychosocial interventions, these findings support the use of oral naltrexone at 50 mg/d and acamprosate as first-line pharmacotherapies for alcohol use disorder.

DOI: 10.1001/jama.2023.19761

Source: https://jamanetwork.com/journals/jama/fullarticle/2811435