Intervention Review

LAAM maintenance vs methadone maintenance for heroin dependence

  1. Nicolas C Clark1,*,
  2. Nicholas Lintzeris2,
  3. Alan Gijsbers3,
  4. Greg Whelan4,
  5. Adrian Dunlop2,
  6. Alison Ritter3,
  7. Walter W Ling5

Editorial Group: Cochrane Drugs and Alcohol Group

Published Online: 16 JUL 2008

Assessed as up-to-date: 4 FEB 2002

DOI: 10.1002/14651858.CD002210

Database Title

Additional Information

How to Cite

Clark NC, Lintzeris N, Gijsbers A, Whelan G, Dunlop A, Ritter A, Ling WW. LAAM maintenance vs methadone maintenance for heroin dependence. Cochrane Database of Systematic Reviews 2002, Issue 2. Art. No.: CD002210. DOI: 10.1002/14651858.CD002210.

Author Information

  1. 1

    Turning Point Alcohol & Drug Centre, Hunter New England Area Health Service,, Fitzroy, Victoria, Australia

  2. 2

    Hunter New England Area Health Service, Turning Point Alcohol & Drug Centre, Fitzroy, Victoria, Australia

  3. 3

    Hunter New England Area Health Service, Turning Point Alcohol & Drug Centre, Fitzroy, Melbourne, Victoria, Australia

  4. 4

    St Vincents Hospital, Centre for Drug and Alcohol Studies, Melbourne, Australia

  5. 5

    Matrix/UCLA Neuropsychiatric Institute and Hospital, Alcoholism and Addiction Medicine Service, Los Angeles, California, USA

*Nicolas C Clark, Hunter New England Area Health Service,, Turning Point Alcohol & Drug Centre, 54-62 Gertrude St, Fitzroy, Victoria, 3065, Australia. nicoc@turningpoint.org.au.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 16 JUL 2008

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

LAAM and methadone are both opiate agonists and have been shown to reduce dependence on heroin when given continuously under supervised dosing conditions. LAAM has a long duration of action requiring dosing every two/three days compared to methadone which requires daily dosing. LAAM is not as widely available internationally as methadone, and may be withdrawn from the market following ten cases of life-threatening cardiac arrhythmias and an association with QT prolongation.

Objectives

To compare the efficacy and acceptability of LAAM maintenance with methadone maintenance in the treatment of heroin dependence.

Search methods

We searched MEDLINE (January 1966 - August 2000), PsycINFO (1887 - August 2000), EMBASE (January 1985 - August 2000), and Cochrane Controlled Trials Register (Issue 2 2000). We hand searched NIDA monographs until August 2000 and reference lists of articles. The specialised register of trials of the Cochrane Group on Drugs and Alcohol was searched until February 2003.

Selection criteria

All randomised controlled trials, controlled clinical trials and controlled prospective studies comparing LAAM and methadone maintenance for the treatment of heroin dependence, outcomes of efficacy or acceptability were included.

Data collection and analysis

Data on retention in treatment, heroin use, side-effects and mortality were collected by two reviewers independently. A meta-analysis was performed using RevMan. Discrepancies were resolved by consensus.

Main results

Eighteen studies, (15 RCTs, 3 Controlled prospective studies) met the inclusion criteria for the review. Three were excluded from the meta-analysis due to lack of data on retention, heroin use or mortality. Cessation of allocated medication (11 studies, 1473 participants) was greater with LAAM than with methadone, (RR 1.36, 95%CI 1.07-1.73, p=0.001, NNT=7.7 (or 8)). Non-abstinence was less with LAAM (5 studies, 983 participants; RR 0.81, 95%CI 0.72-0.91, p=0.0003, NNT=9.1 (or 10)). In 10 studies (1441 participants) there were 6 deaths from a range of causes, 5 in participants assigned to LAAM (RR 2.28 (95%CI 0.59-8.9, p=0.2). other relevant outcomes, such as quality of life and criminal activity could not be analysed because of lack of information in the primary studies.

Authors' conclusions

LAAM appears more effective than methadone at reducing heroin use. More LAAM patients than methadone ceased their allocated medication during the studies, but many transferred to methadone and so the significance of this is unclear. There was no difference in safety observed, although there was not enough evidence to comment on uncommon adverse events.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

LAAM may be more effective at reducing heroin dependence than methadone, but it is associated with adverse effects, some of which may be life-threatening

Opiate drugs are used to help people reduce their dependence on heroin (an opiate drug). Methadone needs daily doses, but the effects do not last 24 hours for many people. A dose of LAAM (levomethadyl acetate hydrochloride) works for two or three days. LAAM is not as widely available internationally as methadone, and may be withdrawn from the market because of concerns about life-threatening effects on the heart. The review found that LAAM is more effective than methadone at reducing heroin dependence, but there was not enough evidence from trials to draw conclusions about safety.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

比較LAAM維持治療和美沙酮維持治療對於海洛因依賴的療效

LAAM和美沙酮都是鴉片受體促進劑，並已證明，在連續的劑量控制下，可減少對海洛因的依賴性。LAAM具有長效的作用時間，須每兩或三天給予藥物劑量，相較於美沙酮，需要每天服用。LAAM並不像美沙酮在國際上被廣泛的使用，追蹤10件危及生命的心律不整案件後，它從市場上被撤回，可能和QT間期延長有關。

目標

比較LAAM和美沙酮維持法對於治療海洛因依賴的療效和患者接受度。

搜尋策略

我們檢索MEDLINE(1966年1月 2000年8月)，PsycINFO(1887年  2000年8月)，醫學文摘庫(1985年1月 2000年8月)和Cochrane對照試驗註冊(2000年第2期)。我們一方面搜查至2000年8月，國家發展管理研究所專著和參考文獻目錄的文章。搜尋至2003年2月，專門登錄Cochrane有關藥物和酒精類的試驗。

選擇標準

所有隨機對照試驗，對照臨床試驗和控制的前瞻性研究，比較對於治療海洛因依賴，使用LAAM和美沙酮維持法的療效或接受度。

資料收集與分析

治療持續性，海洛因使用，副作用和死亡率的數據分別獨立由兩名評審者所收集。利用RevMan進行整合分析。差異以協商一致方式獲得解決。

主要結論

18個研究，(15隨機對照試驗，3控制的前瞻性研究)符合納入此回顧的審查標準。由於缺乏數據保留，海洛因使用或死亡，三個研究被整合分析所排除。在(11項研究，1473受試者)LAAM比美沙酮治療有較多的停止藥物分配，(RR:1.36，95％CI為1.07 – 1.73，p = 0.001，即是治療 7.7或8就有一人會發生此現象)。LAAM組有較少的非戒斷症狀(5研究，983受試者RR:0.81，95％CI為0.72 – 0.91，p = 0.0003，即是治療 9.1或10有一人會發生此現象)。在10項研究(1441受試者)有6人死於可觀察的原因，5人來自於使用LAAM組的受試者(RR:2.28(95％CI為0.59 – 8.9，p = 0.2)。其他相關結果，如生活品質和犯罪活動力，由於缺乏原始研究的資訊而無法進行分析。

作者結論

LAAM比美沙酮似乎更有效率在減少海洛因的使用。更多服用LAAM比美沙酮的病人在研究期間停止服藥的分配，但許多病人換成使用美沙酮，所以其意義仍不清楚。雖然沒有足夠的證據評論罕見的不良事件，但是在安全上的觀察，似乎沒有任何差異。

翻譯人

本摘要由高雄榮民總醫院洪碧蓮翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

LAAM可能比美沙酮更有效地減輕海洛因依賴，但它帶來了不利的影響，其中一些可能是危害生命的。鴉片類藥物是用來幫助人們減少對海洛因的依賴。美沙酮需要每天服用，但藥效對許多人來說，並不會持續24小時。LAAM(levomethadyl)劑量可維持兩至三天。LAAM並不像美沙酮在國際上被廣泛的使用，因為有關心臟方面致命的危害可能被退出市場。此回顧發現，LAAM在減少海洛因依賴的效果優於美沙酮，但從這些試驗中沒有足夠的證據獲得有關使用安全的結論。

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