Effectiveness of Alcohol Use Disorder Pharmacotherapies by Sex: Systematic Review and Meta-Analysis

IF 2.9 3区医学 Q2 SUBSTANCE ABUSE

Drug and alcohol review Pub Date : 2026-06-23 DOI:10.1111/dar.70196

Juliette Allen, Andrew Jones, Gillian W. Shorter, Catharine Montgomery, Zetta Kougiali, Alina Bagnall, Claire Adshead, Jessie Smith, Sam Burton, Amanda Atkinson, Lillian Guelen, Abigail Rose

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Abstract

Issues

Alcohol use disorder (AUD) shows sex-related differences in prevalence, harm and treatment response. Despite growing interest in sex differences, evidence synthesis evaluating pharmacotherapy effectiveness by sex remains limited.

Approach

Web of Science, PubMed, Scopus, PsycINFO and Cochrane were searched twice. Eligible records included RCTs or non-randomised studies of adults with AUD receiving pharmacological interventions (licensed or off-label), and reporting or providing outcomes (binary relapse or continuous alcohol consumption change) by sex. Multi-level random-effects models calculated risk ratios (RR) and standardised mean differences (SMD), with sex as a moderator.

Key Findings

Twenty-eight studies (25,041 participants, 25% female) were included. No outcomes were rated low risk of bias; non-RCTs were moderate-to-high quality. Overall treatment effects vs. control were small for abstinence (RR = 0.96, 95% CI [0.52, 1.74]; 4 studies; I² = 95%) and modest for consumption reduction (SMD = 0.23, 95% CI [0.01, 0.45]; 13 studies; I² = 89%); sex did not meaningfully moderate these outcomes (ratio of RR = 1.04, 95% CI [0.87, 1.25]; ΔSMD = 0.05, 95% CI [−0.09, 0.18]). Power was low (median 13.7%), requiring ~6358 participants per group to detect the observed sex difference. Narrative synthesis suggested possible sex differences for naltrexone and baclofen, while highlighting the influence of drug (e.g., tolerability), participant (e.g., drinking motives) and design factors (e.g., recruitment setting) on treatment response.

Implications

AUD pharmacotherapies provide modest benefits, with sex differences remaining unclear. Future trials should be adequately powered, report sex-specific outcomes and consider adherence, tolerability and psychosocial moderators.

Conclusion

Evidence for sex-specific efficacy remains inconclusive. Patterns for naltrexone and baclofen warrant exploration in large, rigorously designed, sex-stratified trials.

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酒精使用障碍药物治疗的性别有效性：系统回顾和荟萃分析。

问题：酒精使用障碍（AUD）在患病率、危害和治疗反应方面显示出与性别相关的差异。尽管人们对性别差异越来越感兴趣，但根据性别评估药物治疗效果的证据合成仍然有限。方法：检索Web of Science、PubMed、Scopus、PsycINFO和Cochrane 2次。符合条件的记录包括接受药物干预（许可或非标签）的成年AUD患者的随机对照试验或非随机研究，并按性别报告或提供结果（二元复发或持续饮酒改变）。多层随机效应模型计算风险比（RR）和标准化平均差异（SMD），性别是调节因素。主要发现：纳入了28项研究（25,041名参与者，25%为女性）。没有结果被评为低偏倚风险；非随机对照试验为中高质量。总体治疗效果与对照组相比，戒断效果较小（RR = 0.96, 95% CI[0.52, 1.74]； 4项研究；I2 = 95%），减少消费效果中等（SMD = 0.23, 95% CI[0.01, 0.45]； 13项研究；I2 = 89%）；性别对这些结果没有显著影响（RR = 1.04, 95% CI [0.87, 1.25]； ΔSMD = 0.05, 95% CI[-0.09, 0.18]）。功率较低（中位数为13.7%），每组需要约6358名参与者来检测观察到的性别差异。叙述性综合提示纳曲酮和巴氯芬可能存在性别差异，同时强调了药物（如耐受性）、参与者（如饮酒动机）和设计因素（如招募环境）对治疗反应的影响。含义：AUD药物治疗提供适度的益处，性别差异尚不清楚。未来的试验应充分支持，报告特定性别的结果，并考虑依从性、耐受性和社会心理调节因素。结论：性别特异性疗效的证据仍不确定。纳曲酮和巴氯芬的模式值得在大型、严格设计、性别分层的试验中探索。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Drug and alcohol review SUBSTANCE ABUSE-

CiteScore

4.80

自引率

10.50%

发文量

151

期刊介绍： Drug and Alcohol Review is an international meeting ground for the views, expertise and experience of all those involved in studying alcohol, tobacco and drug problems. Contributors to the Journal examine and report on alcohol and drug use from a wide range of clinical, biomedical, epidemiological, psychological and sociological perspectives. Drug and Alcohol Review particularly encourages the submission of papers which have a harm reduction perspective. However, all philosophies will find a place in the Journal: the principal criterion for publication of papers is their quality.