Combined pharmacotherapies for the management of alcoholism: rationale and evidence to date.
Combined pharmacotherapies for the management of alcoholism: rationale and evidence to date.
复制标题
治疗酒精中毒的联合药物疗法：迄今为止的基本原理和证据。
DOI：
10.1007/s40263-013-0137-z
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发表时间：
2014
期刊：
影响因子：
6
通讯作者：
Leggio,Lorenzo
中科院分区：
文献类型：
--
作者：
Lee,MaryR;Leggio,Lorenzo
酒精使用障碍（AUD）的药物治疗效果有限。改善AUD治疗结果的一种方法是将已显示出一定疗效的单独药物联合收割机药物疗法组合。联合用药的基本原理基于以下原则：联合用药可以靶向AUD中功能失调的一种以上神经递质系统，可以靶向不同的饮酒行为（即，正强化和负强化），可以治疗共病的精神和医学障碍，并且可以使副作用最小化，通过组合使用较低剂量的每种药物来改善对治疗的依从性。联合药物治疗策略可能会产生累加甚至协同效应，以减少酒精渴望和消费。在这里，我们回顾了研究药物组合对酒精相关结果的影响的文献，这些药物组合在动物研究和临床试验中显示出作为单一药物减少饮酒的功效。我们集中研究了17项研究药物联合治疗AUD的临床研究，其中11项是随机、双盲和安慰剂对照的。11项研究中有10项显示联合用药优于安慰剂，但只有3项显示联合用药优于单药。总的来说，这些研究使用了不同的方法，评估严重程度，结果测量和连续的心理社会治疗。目前发表的研究和新的组合可能的未来方向的局限性进行了讨论。
Pharmacotherapies for alcohol use disorders (AUDs) have limited efficacy. One approach to improving treatment outcomes for AUDs is to combine pharmacotherapies that have shown some efficacy as individual agents. The rationale for combining medications rests on the following principles: a combination of medications can target more than one neurotransmitter system that is dysfunctional in AUDs, can target different drinking behaviors (i.e., positive and negative reinforcement), can treat co-morbid psychiatric and medical disorders, and can minimize side effects, improving adherence to treatment by using lower doses of each drug in combination. Combined pharmacotherapy strategies may produce additive or even synergistic effects to decrease alcohol craving and consumption. Here, we reviewed the literature investigating the effect on alcohol-related outcomes of combinations of medications that have shown efficacy as single agents to reduce drinking in animal studies and clinical trials. We focused on 17 clinical studies investigating the combination of medications in AUDs, 11 of which were randomized, double-blind, and placebo-controlled. Ten of the 11 studies showed the combination to be superior to placebo, but only three showed an advantage of the combination compared with the single agent. Overall, these studies used diverse methodologies, assessments of severity, outcome measures, and adjunctive psychosocial treatments. Limitations of the current published studies and possible future directions for new combinations are discussed.