英国布里斯托大学David Kessler团队研究了初级保健中维持戒酒的治疗干预措施。2020年11月25日，该研究发表在《英国医学杂志》上。

为了确定在初级保健中对最近戒酒患者的最有效干预措施，研究组在Medline、Embase、PsycINFO、ClinicalTrials.gov等大型数据库中进行检索，筛选出初级保健中对酒精依赖患者进行两种及以上戒断干预措施的随机对照试验，并进行系统回顾和网络荟萃分析。主要结果是开始干预至少12周后的持续戒酒率和全因中断率。

该研究共纳入64项试验，包括43项干预措施。安慰剂组患者戒断的平均机率为25％。与安慰剂相比，唯一增加戒断概率的中等确定性证据的干预措施是阿坎酸。在62项报告了全因中断的试验中，与安慰剂相比，中断率下降中度确定性证据的干预措施为阿坎酸、纳曲酮和阿坎酸-纳曲酮。阿坎酸是唯一的与中等置信相关的干预措施，有效期长达12个月。由于对证据的置信不足，尚不确定其他干预措施是否能帮助维持戒断并减少中断率。

总之，在初级保健机构中戒酒，除阿坎酸以外，尚未有其他有效干预措施。

附：英文原文

Title: Treatment interventions to maintain abstinence from alcohol in primary care: systematic review and network meta-analysis

Author: Hung-Yuan Cheng, Luke A McGuinness, Roy G Elbers, Georgina J MacArthur, Abigail Taylor, Alexandra McAleenan, Sarah Dawson, José A López-López, Julian P T Higgins, Sean Cowlishaw, Anne Lingford-Hughes, Matthew Hickman, David Kessler

Issue&Volume: 2020/11/25

Abstract:

Objective To determine the most effective interventions in recently detoxified, alcohol dependent patients for implementation in primary care.

Design Systematic review and network meta-analysis.

Data sources Medline, Embase, PsycINFO, Cochrane CENTRAL, ClinicalTrials.gov, and the World Health Organization’s International Clinical Trials Registry Platform.

Study selection 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.

Data extraction 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.

Results 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.

Conclusions 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.

DOI: 10.1136/bmj.m3934

Source: https://www.bmj.com/content/371/bmj.m3934