Benzodiazepines for alcohol withdrawal

 

Abstract

Background

Alcohol abuse and dependence represents a serious health problem worldwide with social, interpersonal and legal interpolations. Benzodiazepines have been widely used for the treatment of alcohol withdrawal symptoms. Moreover it is unknown whether different benzodiazepines and different regimens of administration may have the same merits.

Objectives

To evaluate the effectiveness and safety of benzodiazepines in the treatment of alcohol withdrawal.

Search methods

Cochrane Drugs and Alcohol Group' Register of Trials (December 2009), PubMed,  EMBASE,  CINAHL (January 1966 to December 2009), EconLIT (1969 to December 2009). Parallel searches on web sites of health technology assessment and related agencies, and their databases.

Selection criteria

Randomized controlled trials examining effectiveness, safety and risk-benefit of benzodiazepines in comparison with placebo or other pharmacological treatment and between themselves. All patients were included regardless of age, gender, nationality, and outpatient or inpatient therapy.

Data collection and analysis

Two authors independently screened and extracted data from studies.

Main results

Sixty four studies, 4309 participants, met the inclusion criteria.

- Comparing benzodiazepines versus placebo, benzodiazepines performed better for seizures, 3 studies, 324 participants, RR 0.16 (0.04 to 0.69), no statistically significant difference for the other outcomes considered.

- Comparing benzodiazepines versus other drugs, there is a trend in favour of benzodiazepines for seizure and delirium control, severe life threatening side effect, dropouts, dropouts due to side effects and patient's global assessment score.  A trend in favour of control group was observed for CIWA-Ar scores at 48 hours and at the end of treatment. The results reach statistical significance only in one study, with 61 participants, results on Hamilton anxiety rating scale favour control MD -1.60 (-2.59 to -0.61)

- Comparing different benzodiazepines among themselves,results never reached statistical significance but chlordiazepoxide performed better

- Comparing benzodiazepine plus other drug versus other drug, results never reached statistical significance.

- In the comparison of fixed-schedule versus symptom-triggered regimens, results from a single study, with 159 participants, favour  symptom-triggered regimens MD -1.10 [-3.27, 1.07] for CIWA-Ar scores at the end of treatment. Differences in isolated trials should be interpreted very cautiously.

Authors' conclusions

Benzodiazepines showed a protective benefit against alcohol withdrawal symptoms, in particular seizures, when compared to placebo and a potentially protective benefit for many outcomes when compared with other drugs. Nevertheless, no definite conclusions about the effectiveness and safety of benzodiazepines was possible, because of the heterogeneity of the trials both in interventions and the assessment of outcomes.

 

Plain language summary

Benzodiazepines for alcohol withdrawal

Benzodiazepines are more effective than placebo against alcohol withdrawal seizures while they have variable profile against other commonly used treatments

This Cochrane review summarizes evidence from sixty-four randomised controlled trials evaluating the effectiveness and safety of benzodiazepines in the treatment of alcohol withdrawal symptoms. The available data show that benzodiazepines are effective against alcohol withdrawal seizures when compared to placebo and a potentially protective benefit for many outcomes when compared with other drugs. Data on safety outcomes are sparse and fragmented.

 

摘要

背景

Benzodiazepines用於酒精戒斷

酒精性依賴的病人在停止或減少酒精量，會出現許多酒精戒斷症狀。這篇系統化的評論主要在回顧benzodiazepines用於治療酒精戒斷症狀之相關證據。

目標

評估benodiazepines用於治療酒精戒斷之成效及安全性。

搜尋策略

搜索Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 4, 2004), MEDLINE (1966 to October 2004) and EUPSI PSITri database.沒有語言限制及文章發表日期限制。同時也篩選相關文章所引用的文獻。

選擇標準

檢查所有隨機對照試驗數據，比較一種benzodiazepine，與placebo、其他藥物、其他類benzodiazepien的藥物等，這些干預在效果及安全上的差異。

資料收集與分析

兩位審核者分別評估試驗的品質及拮取數據資料。

主要結論

4051位病患參與的57個臨床實驗，雖然有許多隨機對照組的結果，不同的結果及不同的評估等級，但綜合評估的量化分析資料很少。對於酒精戒斷後癲癇發作，與placeo比較，Benzodiaepines提供較多的的益處 ([RR] 0.16; 95%confidence interval [CI] 0.04 to 0.69; p = 0.01)。和其他類的藥物比較，Benzodiazepienes有類似的成功機率(RR 1.00; 95% CI 0.83 to 1.21)， 但與anticonvulsants相比，沒有差異(RR 0.88; 95% CI 0.60 to 1.30)。 Changes in Clinical Institute Withdrawal Assessment for Alcohol (CIWAAr)等級，在治療結束的等級評估，不論是benzodizepines 或其他藥物，都呈現類似結果，然而有少數一些小型研究出現與其他研究不同的等級評估結果。其他的數據比較非常有限，所以綜合分析不同的結果，不能提供非常多的資訊。

作者結論

與placebo比較，Beznodiazepines對於酒精戒斷症狀的癲癇發作特別有效。因為許多異質的處置方式及評估結果，無法下決定性的結論： benzodiazepines與其他藥物相比，對酒精戒斷相對有效及安全性在成功率上，bezodiazepiens與其他藥物相比，沒有顯著差異。

翻譯人

本摘要由高雄榮民總醫院陳淑梅翻譯。

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

總結

Benzodiazepines對酒精戒斷引發之癲癇發作，比placebo較有效。比起其他常見的治療，Benzodiazepines有更多的治療特性。Cocharnce review摘錄57個隨機對照試驗的數據，評估benzodiazepines用於治療酒精戒斷症狀的有效性及安全性。現有的數據顯示與placebo比較時，benzodiazepines對於酒精戒斷的癲癇發作較有效。然而在成功率的比較上，benzodiazepines與其他藥物沒有明顯的差異。在安全性的分析上，數據相當稀少及片斷，在這個領域需要進行一個大型及設計良好的臨床實驗。