Predischarge Injectable Versus Oral Naltrexone to Improve Postdischarge Treatment Engagement Among Hospitalized Veterans with Alcohol Use Disorder: A Randomized Pilot Proof-of-Concept Study.
Predischarge Injectable Versus Oral Naltrexone to Improve Postdischarge Treatment Engagement Among Hospitalized Veterans with Alcohol Use Disorder: A Randomized Pilot Proof-of-Concept Study.
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DOI：
10.1111/acer.13410
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发表时间：
2017-07
期刊：
影响因子：
--
通讯作者：
Brown R
中科院分区：
文献类型：
--
作者：
Busch AC;Denduluri M;Glass J;Hetzel S;Gugnani SP;Gassman M;Krahn D;Deyo B;Brown R
在一些研究中，注射纳曲酮治疗酒精使用障碍（AUDs）是有效的。它还没有(1)与口服纳曲酮进行正面比较，或(2)在医院环境中作为一种干预措施进行检查，以促进出院后的治疗出勤率。54名确诊患有DSM-IV酒精依赖的住院退伍军人随机接受：(1)50毫克口服纳曲酮加30天处方，或(2)出院前380毫克肌内纳曲酮注射。根据筛选标准，113名退伍军人住院患者被认为符合条件，其中54名符合最终资格标准，并被纳入和随机化。基线数据包括人口统计、酒精消费和合并症。在14天和45天的随访中重新评估治疗开始和参与以及酒精消耗的措施。35名参与者（64.8%）完成了整个研究方案（接受了研究药物治疗并完成了14天和45天的随访）。在接受研究药物治疗的患者中（n=45）， 77.8%的患者完成了所有随访访谈。这项初步研究的设计没有足够的统计能力来进行假设检验，因此，正如预期的那样，两组之间在药物依从性方面没有显著差异(口服组自我报告每日服用剂量的80%；注射组接受第二次注射)、治疗参与（出院后30天内至少治疗3次，出院后3个月内每月至少治疗2次）或第14天或第45天饮酒（p>0.05）。整个队列在住院前两周的饮酒中位数（128次饮酒）显著高于第14天（0次饮酒，p<0.001）或第45天（0次饮酒，p<0.001）。口服组的药物依从率为62%，注射组为61%。结果表明进行更大规模、更明确的研究是可行的。随着时间的推移，两组的饮酒量都显著减少，治疗参与率也很高。对于确定患有AUD的住院患者，在出院前口服和注射制剂都是可行的。
Injectable naltrexone for alcohol use disorders (AUDs) has been efficacious in several studies. It has not been (1) compared head-to-head with oral naltrexone, or (2) examined in the hospital setting as an intervention that might facilitate treatment attendance after hospital discharge. Fifty-four hospitalized veterans identified as having DSM-IV alcohol dependence were randomized to receive: (1) a 50 mg oral naltrexone plus a 30-day prescription, or (2) a 380 mg intramuscular naltrexone injection prior to discharge. Of 113 veteran inpatients deemed eligible based on screening criteria, 54 met final eligibility criteria and were enrolled and randomized. Baseline data included demographics, alcohol consumption and co-morbidity. Measures of treatment initiation and engagement and alcohol consumption were reassessed at 14-day and 45-day follow ups. Thirty-five participants (64.8%) completed the entire study protocol (received a study medication and completed 14- and 45-day follow ups). Among those who received a study medication (n=45), 77.8% completed all follow-up interviews. This pilot study was not designed to have sufficient statistical power for hypothesis testing, and thus, as expected, there were no significant differences between groups in medication adherence (self-report of > 80% of daily doses taken in oral group; receipt of second injection in the injection group), treatment engagement (at least treatment 3 visits in the 30 days post-discharge, and 2 or more visits per month in each of the 3 months following discharge) or alcohol consumption at 14 or at 45 days (p>0.05). The median number of drinks among the entire cohort in the two weeks prior to hospitalization (128 drinks) was significantly higher than at Day 14 (0 drinks, p<0.001) or Day 45 (0 drinks, p<0.001). Rates of medication adherence were 62% in the oral group and 61% in the injection group Results indicate feasibility for larger, more definitive study. Both groups had significant reductions in alcohol consumption over time and high treatment engagement rates. Both oral and injectable formulations are feasible to initiate prior to discharge for hospital inpatients identified as having an AUD.
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影响因子：
9.3
作者：
Kuffner, E. K.;Green, J. L.;Bogdan, G. M.;Knox, P. C.;Palmer, R. B.;Heard, K.;Slattery, J. T.;Dart, R. C.
通讯作者：
Dart, R. C.
影响因子：
2.6
作者：
DiIorio, C;Shafer, PO;Yeager, K
通讯作者：
Yeager, K
影响因子：
120.7
作者：
Garbutt, JC;Kranzler, HR;Ehrich, EW
通讯作者：
Ehrich, EW
影响因子：
120.7
作者：
McLellan, AT;Lewis, DC;Kleber, HD
通讯作者：
Kleber, HD
影响因子：
7
作者：
Manea, Laura;Gilbody, Simon;McMillan, Dean
通讯作者：
McMillan, Dean