酒精使用障碍的药物治疗和酒精相关住院风险：一项登记研究

IF 5.3 2区医学 Q1 PSYCHIATRY

Acta Psychiatrica Scandinavica Pub Date : 2025-03-17 DOI:10.1111/acps.13802

Patrick Bach, Johan Franck, Jonas Hällgren, Härje Widing, Mika Gissler, Jeanette Westman

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引用次数: 0

摘要

目的：尽管酒精使用障碍（AUD）的患病率很高，但只有少数患者接受推荐的药物治疗，可能是由于这些药物在现实世界中的有效性不确定。在这里，我们分析了全国范围内基于登记的数据，以调查批准的AUD药物（纳曲酮、阿坎普罗酸、双硫仑和纳美芬）与AUD患者酒精相关住院风险之间的关系。方法：从瑞典国家患者登记册中确定2009年至2019年首次诊断为AUD的18-64岁患者（N = 93,727）。使用Cox回归模型分析AUD药物暴露与酒精相关住院风险之间的关系。结果：纳曲酮暴露(危险比[HR] = 0.80；95%可信区间[CI] = 0.73-0.87)或双硫仑（HR = 0.83, 95% CI = 0.79-0.88）作为单一疗法，或纳曲酮/双硫仑（HR = 0.68, 95% CI = 0.49-0.96）或双硫仑/阿坎普罗酸（HR = 0.57, 95% CI = 0.44-0.74）与未使用任何这些药物的时期相比，酒精相关住院的风险较低显著相关。相比之下，阿坎普罗酸、纳美芬或阿坎普罗酸/纳曲酮联合用药未观察到显著相关性。严重AUD患者的敏感性分析和不同社会经济群体的分层亚组分析证实了结果的稳健性。结论：研究结果表明，双硫仑与纳曲酮单药治疗，以及双硫仑与纳曲酮或阿坎普罗酸联合用药，与AUD患者酒精相关住院的风险较低。低处方率表明AUD药物目前未得到充分利用。增加这些药物对AUD患者的可用性有助于减少与酒精相关的住院治疗。

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Pharmacological Treatments in Alcohol Use Disorder and Risk of Alcohol-Related Hospitalizations: A Register Study.

Objectives: Despite the high prevalence of alcohol use disorder (AUD), only a minority of patients receive recommended pharmacological treatments, possibly owing to uncertainty about the real-world effectiveness of these medications. Here, we analyzed nationwide, register-based data to investigate the association between approved AUD medications (naltrexone, acamprosate, disulfiram, and nalmefene) and the risk of alcohol-related hospitalizations among individuals with AUD.

Methods: People aged 18-64 with a registered first-time diagnosis of AUD between 2009 and 2019 (N = 93,727) were identified from the Swedish National Patient Register. Cox regression models were used to analyze the association between AUD medication exposure and the risk of alcohol-related hospitalizations.

Results: Exposure to naltrexone (hazard ratio [HR] = 0.80; 95% confidence interval [CI] = 0.73-0.87) or disulfiram (HR = 0.83, 95% CI = 0.79-0.88) as monotherapy, or a combination of naltrexone/disulfiram (HR = 0.68, 95% CI = 0.49-0.96), or disulfiram/acamprosate (HR = 0.57 95% CI = 0.44-0.74) was significantly associated with a lower risk of alcohol-related hospitalizations compared to periods without exposure to any of these medications. In contrast, no significant associations were observed for acamprosate, nalmefene, or the combination of acamprosate/naltrexone. Sensitivity analyses in individuals with severe AUD and stratified subgroup analyses by different socioeconomic groups confirmed the robustness of the results.

Conclusion: Results indicate a significant association between disulfiram and naltrexone monotherapy, as well as the combination of disulfiram with naltrexone or acamprosate, with a lower risk of alcohol-related hospitalizations among individuals with AUD. Low prescription rates suggest that AUD medications are currently underutilized. Increasing the availability of these medications for individuals with AUD could help reduce alcohol-related hospitalizations.

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来源期刊

Acta Psychiatrica Scandinavica 医学-精神病学

CiteScore

11.20

自引率

3.00%

发文量

135

审稿时长

6-12 weeks

期刊介绍： Acta Psychiatrica Scandinavica acts as an international forum for the dissemination of information advancing the science and practice of psychiatry. In particular we focus on communicating frontline research to clinical psychiatrists and psychiatric researchers. Acta Psychiatrica Scandinavica has traditionally been and remains a journal focusing predominantly on clinical psychiatry, but translational psychiatry is a topic of growing importance to our readers. Therefore, the journal welcomes submission of manuscripts based on both clinical- and more translational (e.g. preclinical and epidemiological) research. When preparing manuscripts based on translational studies for submission to Acta Psychiatrica Scandinavica, the authors should place emphasis on the clinical significance of the research question and the findings. Manuscripts based solely on preclinical research (e.g. animal models) are normally not considered for publication in the Journal.