Treatment interventions to maintain abstinence from alcohol in primary care: systematic review and network meta-analysis.
Treatment interventions to maintain abstinence from alcohol in primary care: systematic review and network meta-analysis.
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DOI：
10.1136/bmj.m3934
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发表时间：
2020-11-25
期刊：
影响因子：
--
通讯作者：
Kessler D
中科院分区：
文献类型：
--
作者：
Cheng HY;McGuinness LA;Elbers RG;MacArthur GJ;Taylor A;McAleenan A;Dawson S;López-López JA;Higgins JPT;Cowlishaw S;Lingford-Hughes A;Hickman M;Kessler D
确定最有效的干预措施，最近脱毒，酒精依赖患者在初级保健的实施。系统综述和网络荟萃分析。Medline、Embase、PsycINFO、科克伦中心、ClinicalTrials.gov和世界卫生组织的国际临床试验注册平台。随机对照试验，比较两种或两种以上可用于初级保健的干预措施。研究对象是通过标准化临床工具诊断的酒精依赖患者，他们在四周内戒毒。关注的结果是干预开始后至少12周的持续戒酒（有效性）和全因脱落（作为可接受性的代表）。纳入了64项试验（43项干预措施）。安慰剂组的中位戒烟概率为25%。与安慰剂相比，与禁欲概率增加和中等确定性证据相关的唯一干预措施是阿坎酸（比值比1.86，95%置信区间1.49至2.33，对应于38%的绝对概率）。在纳入的62项报告全因脱落的试验中，与安慰剂相比，干预措施与脱落人数减少相关（概率50%）和中等确定性的证据是阿坎酸（0.73，0.62至0.86; 42%），纳曲酮（0.70，0.50至0.98; 41%）和阿坎酸-纳曲酮（0.30，0.13至0.67; 17%）。阿坎酸是唯一一种在长达12个月的有效性和可接受性证据中具有中等信心的干预措施。由于对证据的信心不足，尚不确定其他干预措施是否有助于维持禁欲和减少辍学。除了阿坎酸之外，缺乏证据表明可以在初级保健环境中实施的戒酒干预措施的益处。需要更多来自高质量随机对照试验的证据，以及使用联合干预措施（药物干预或药物和心理干预的组合）来改善初级保健中酒精依赖治疗的策略。PROSPERO CRD 42016049779。
To determine the most effective interventions in recently detoxified, alcohol dependent patients for implementation in primary care. Systematic review and network meta-analysis. Medline, Embase, PsycINFO, Cochrane CENTRAL, ClinicalTrials.gov, and the World Health Organization’s International Clinical Trials Registry Platform. Randomised controlled trials comparing two or more interventions that could be used in primary care. The population was patients with alcohol dependency diagnosed by standardised clinical tools and who became detoxified within four weeks. Outcomes of interest were continuous abstinence from alcohol (effectiveness) and all cause dropouts (as a proxy for acceptability) at least 12 weeks after start of intervention. 64 trials (43 interventions) were included. The median probability of abstinence across placebo arms was 25%. Compared with placebo, the only intervention associated with increased probability of abstinence and moderate certainty evidence was acamprosate (odds ratio 1.86, 95% confidence interval 1.49 to 2.33, corresponding to an absolute probability of 38%). Of the 62 included trials that reported all cause dropouts, interventions associated with a reduced number of dropouts compared with placebo (probability 50%) and moderate certainty of evidence were acamprosate (0.73, 0.62 to 0.86; 42%), naltrexone (0.70, 0.50 to 0.98; 41%), and acamprosate-naltrexone (0.30, 0.13 to 0.67; 17%). Acamprosate was the only intervention associated with moderate confidence in the evidence of effectiveness and acceptability up to 12 months. It is uncertain whether other interventions can help maintain abstinence and reduce dropouts because of low confidence in the evidence. Evidence is lacking for benefit from interventions that could be implemented in primary care settings for alcohol abstinence, other than for acamprosate. More evidence from high quality randomised controlled trials is needed, as are strategies using combined interventions (combinations of drug interventions or drug and psychosocial interventions) to improve treatment of alcohol dependency in primary care. PROSPERO CRD42016049779.
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影响因子：
3.7
作者：
Cheng HY;Elbers RG;Higgins JP;Taylor A;MacArthur GJ;McGuinness L;Dawson S;López-López JA;Cowlishaw S;Hickman M;Kessler D
通讯作者：
Kessler D
影响因子：
25.8
作者：
Gustafson, David H.;McTavish, Fiona M.;Chih, Ming-Yuan;Atwood, Amy K.;Johnson, Roberta A.;Boyle, Michael G.;Levy, Michael S.;Driscoll, Hilary;Chisholm, StevenM.;Dillenburg, Lisa;Isham, Andrew;Shah, Dhavan
通讯作者：
Shah, Dhavan
影响因子：
6
作者：
Dawson, Deborah A.;Grant, Bridget F.;Chou, Patricia S.
通讯作者：
Chou, Patricia S.
影响因子：
39.2
作者：
Hutton, Brian;Salanti, Georgia;Moher, David
通讯作者：
Moher, David
影响因子：
4.1
作者：
Lingford-Hughes, A. R.;Welch, S.;Winstock, A.
通讯作者：
Winstock, A.