Relative effectiveness of medications for opioid-related disorders: A systematic review and network meta-analysis of randomized controlled trials.
Relative effectiveness of medications for opioid-related disorders: A systematic review and network meta-analysis of randomized controlled trials.
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DOI：
10.1371/journal.pone.0266142
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发表时间：
2022
期刊：
影响因子：
3.7
通讯作者：
Panagiotoglou D
中科院分区：
文献类型：
--
作者：
Lim J;Farhat I;Douros A;Panagiotoglou D
几种药物治疗干预措施可用于阿片类药物相关疾病的维持治疗。然而，之前的荟萃分析仅限于这些干预措施的成对比较，并且它们相对于所有其他干预措施的功效仍不清楚。我们的目标是统一不同医疗保健实践的发现，并生成证据，以加强针对阿片类药物使用障碍最广泛处方药物的临床治疗方案。我们检索了 Medline、EMBASE、PsycINFO、CENTRAL 和 ClinicalTrials.gov，查找从数据库建立到 2022 年 2 月 12 日的所有相关随机对照试验 (RCT)。主要结局是治疗保留，次要结局是通过尿液分析测量阿片类药物的使用情况。我们使用贝叶斯网络荟萃分析 (NMA) 计算了风险比 (RR) 和 95% 可信区间 (CrI)，以获取可用证据。我们使用网络元分析工具的置信度评估了 NMA 的可信度。 79 项 RCT 符合纳入标准。由于研究之间测量阿片类药物使用和报告格式的异质性，我们仅针对治疗保留进行 NMA。美沙酮是网络中排名最高的干预措施（累积排名下的表面[SUCRA] = 0.901），而对照是最低的（SUCRA = 0.000）。在治疗保留方面，美沙酮优于丁丙诺啡（RR = 1.22；95% CrI = 1.06–1.40），丁丙诺啡优于纳曲酮（RR = 1.39；95% CrI = 1.10–1.80）。然而，由于高质量试验数量有限，对涉及纳曲酮和缓释口服吗啡 (SROM) 的其他治疗组合的网络估计的置信度仍然较低。所有治疗组的保留率均高于非药物治疗对照组。然而，需要额外的高质量随机对照试验来更准确地估计纳曲酮和 SROM 相对于其他药物的疗效程度。对于已确定疗效的药物疗法，可能有必要对其长期比较有效性进行评估。本系统评价已在 PROSPERO (https://www.crd.york.ac.uk/prospero) 注册（标识符 CRD42021256212）。
Several pharmacotherapeutic interventions are available for maintenance treatment for opioid-related disorders. However, previous meta-analyses have been limited to pairwise comparisons of these interventions, and their efficacy relative to all others remains unclear. Our objective was to unify findings from different healthcare practices and generate evidence to strengthen clinical treatment protocols for the most widely prescribed medications for opioid-use disorders. We searched Medline, EMBASE, PsycINFO, CENTRAL, and ClinicalTrials.gov for all relevant randomized controlled trials (RCT) from database inception to February 12, 2022. Primary outcome was treatment retention, and secondary outcome was opioid use measured by urinalysis. We calculated risk ratios (RR) and 95% credible interval (CrI) using Bayesian network meta-analysis (NMA) for available evidence. We assessed the credibility of the NMA using the Confidence in Network Meta-Analysis tool. Seventy-nine RCTs met the inclusion criteria. Due to heterogeneity in measuring opioid use and reporting format between studies, we conducted NMA only for treatment retention. Methadone was the highest ranked intervention (Surface Under the Cumulative Ranking [SUCRA] = 0.901) in the network with control being the lowest (SUCRA = 0.000). Methadone was superior to buprenorphine for treatment retention (RR = 1.22; 95% CrI = 1.06–1.40) and buprenorphine superior to naltrexone (RR = 1.39; 95% CrI = 1.10–1.80). However, due to a limited number of high-quality trials, confidence in the network estimates of other treatment pairs involving naltrexone and slow-release oral morphine (SROM) remains low. All treatments had higher retention than the non-pharmacotherapeutic control group. However, additional high-quality RCTs are needed to estimate more accurately the extent of efficacy of naltrexone and SROM relative to other medications. For pharmacotherapies with established efficacy profiles, assessment of their long-term comparative effectiveness may be warranted. This systematic review has been registered with PROSPERO (https://www.crd.york.ac.uk/prospero) (identifier CRD42021256212).