近日，加拿大麦克马斯特大学Thomas Agoritsas团队比较了促进苯二氮卓类药物和其他镇静催眠药戒断的干预措施的有效性。该项研究成果发表在2025年6月17日出版的《英国医学杂志》上。

为了回顾来自随机试验的证据，评估苯二氮卓类药物和密切相关的镇静催眠药（BSH）的解除处方策略的有效性，研究组进行了一项随机对照试验的系统评价和荟萃分析。数据来源为MEDLINE、 Embase、CINAHL、PsycInfo、CENTRAL，检索自成立至2024年8月，以及纳入研究和类似系统综述的参考文献列表。

研究组将使用BSH治疗失眠的成年人随机分组到旨在减轻BSH处方的干预措施中，以及在医疗保健中实施这些干预措施的策略。由评审员独立工作，一式两份筛选搜索。通过提取数据，评估偏倚风险。将类似的干预措施分组在一起，进行频率随机效应荟萃分析，并使用GRADE（建议评估、发展和评估分级）方法评估证据的确定性。

该综述共确定了58篇论文，报道了49项独特的试验，其中超过39000名患者。干预措施分为以下几类：逐渐减少、患者教育、医生教育、患者和医生联合教育、认知行为治疗、药物回顾、正念、动机性访谈、药剂师主导干预和药物辅助逐渐减少和戒断。低确定性证据表明，与常规护理相比，患者教育（每1000名患者144人（95%置信区间61至246）多）、药物审查（104人（34至191）多）和药剂师主导的教育干预（491人（234至928）多）可能会增加停止BSH治疗的患者比例。中等确定性证据表明，患者的教育可能对身体功能、心理健康以及失眠的症状和体征几乎没有影响。

没有证据表明药物审查或药剂师主导的教育干预的其他结果。没有令人信服的证据表明，其他干预措施可能有助于患者停止BSH。此外，没有发现高或中等确定性的证据表明任何干预措施都会导致停药率的增加。最后，低确定性证据表明，多组分干预可能比单一组分干预更有效地促进BSH的停止。

研究结果表明，干预终止BSH的有效性证据的确定性较低。对患者进行教育，进行药物评估，以及药剂师主导的教育干预可能会增加停用BSH的患者比例。

附：英文原文

Title: Comparative effectiveness of interventions to facilitate deprescription of benzodiazepines and other sedative hypnotics: systematic review and meta-analysis

Author: Dena Zeraatkar, Sumanth Kumbargere Nagraj, Michael Ling, Tanvir Jassal, Sarah Kirsh, Joo Pedro Lima, Tyler Pitre, Rachel Couban, Muizz Hussain, Siri Seterelv, Stijn Van de Velde, Katarzyna Gustavsson, Adam Wichniak, Carole E Aubert, Antoine Christiaens, Anne Spinewine, Thomas Agoritsas

Issue&Volume: 2025/06/17

Abstract:

Objective To review evidence from randomised trials assessing the effectiveness of strategies to deprescribe benzodiazepines and closely related sedative hypnotics (BSH).

Design Systematic review and meta-analysis of randomised controlled trials.

Data sources MEDLINE, Embase, CINAHL, PsycInfo, and CENTRAL, searched from inception to August 2024, and reference lists of included studies and similar systematic reviews.

Eligibility criteria for selecting studies Eligible studies randomised adults using BSH for insomnia to interventions aimed at deprescribing BSH, strategies to implement these interventions in healthcare settings, or usual care or placebo.

Methods Reviewers worked independently and in duplicate to screen search results, extract data, and assess risk of bias. Similar interventions were grouped together, frequentist random effects meta-analysis was conducted, and the certainty of evidence was assessed using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach.

Results The review identified 58 publications reporting on 49 unique trials with more than 39000 patients. Interventions were classified into the following categories: tapering, patient education, physician education, combined patient and physician education, cognitive behavioural therapy, medication review, mindfulness, motivational interviewing, pharmacist led interventions, and drug assisted tapering and withdrawal. Low certainty evidence suggests that education of patients (144 (95% confidence interval 61 to 246) more per 1000 patients), medication review (104 (34 to 191) more), and a pharmacist led educational intervention (491 (234 to 928) more) may increase the proportion of patients who discontinue BSH compared with usual care. Moderate certainty evidence suggests that education of patients probably has little or no effect on physical function, mental health, and signs and symptoms of insomnia. No evidence was found regarding these other outcomes for medication review or for the pharmacist led educational intervention. No compelling evidence was found that other interventions may help patients to discontinue BSH. Moreover, no high or moderate certainty evidence was found that any of the interventions caused an increase in dropouts. Finally, low certainty evidence suggests that multicomponent interventions may be more effective at facilitating discontinuation of BSH than single component interventions.

Conclusion The evidence on the effectiveness of interventions to discontinue BSH is of low certainty. Educating patients, doing medication reviews, and a pharmacist led educational intervention may increase the proportion of patients who discontinue BSH.

DOI: 10.1136/bmj-2024-081336

Source: https://www.bmj.com/content/389/bmj-2024-081336