Real‐world effectiveness of pharmacological treatments of alcohol use disorders in a Swedish nation‐wide cohort of 125 556 patients.
Background and aim: Pharmacotherapy for alcohol use disorder (AUD) is recommendable, but under‐used, possibly due to deficient knowledge of medications. This study aimed to investigate the real‐world effectiveness of approved pharmacological treatments (disulfiram, acamprosate, naltrexone and nalmef...
| Publicado en: | Addiction Vol. 116; no. 8; pp. 1990 - 1999 |
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| Autores principales: | , , , , , |
| Formato: | research tables/charts Journal Article |
| Publicado: |
Wiley-Blackwell
Aug2021
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=151210161&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 151210161 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 09652140 AIO jtl: Addiction issn: 09652140 maglogo: Y pubinfo: dt: Aug2021 vid: 116 iid: 8 pid: 480 pub: Wiley-Blackwell place: Malden, Massachusetts artinfo: ui: 151210161 148091475 151210161 151210161 10.1111/add.15384 151210161 ppf: 1990 ppct: 9 formats: fmt: – @attributes: type: T – @attributes: type: C – @attributes: type: P tig: atl: Real‐world effectiveness of pharmacological treatments of alcohol use disorders in a Swedish nation‐wide cohort of 125 556 patients. aug: au: Heikkinen, Milja Taipale, Heidi Tanskanen, Antti Mittendorfer‐Rutz, Ellenor Lähteenvuo, Markku Tiihonen, Jari affil: Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland sug: subj: Alcohol-Related Disorders Drug Therapy Alcohol Deterrents Therapeutic Use Treatment Outcomes Sweden Human Adolescence Adult Middle Age Disulfiram Acamprosate Calcium Naltrexone Antianxiety Agents, Benzodiazepine Prospective Studies Hospitalization Multivariate Analysis Cox Proportional Hazards Model Regression Confidence Intervals Adolescent: 13-18 years Adult: 19-44 years Middle Aged: 45-64 years ab: Background and aim: Pharmacotherapy for alcohol use disorder (AUD) is recommendable, but under‐used, possibly due to deficient knowledge of medications. This study aimed to investigate the real‐world effectiveness of approved pharmacological treatments (disulfiram, acamprosate, naltrexone and nalmefene) of AUD. Design A nation‐wide, register‐based cohort study. Setting: Sweden. Participants: All residents aged 16–64 years living in Sweden with registered first‐time treatment contact due to AUD from July 2006 to December 2016 (n = 125 556, 62.5% men) were identified from nation‐wide registers. Measurements The main outcome was hospitalization due to AUD. The secondary outcomes were hospitalization due to any cause, alcohol‐related somatic causes, as well as work disability (sickness absence or disability pension), and death. Mortality was analysed with between‐individual analysis using a traditional multivariate‐adjusted Cox hazards regression model. Recurrent outcomes, such as hospitalization‐based events and work disability, were analysed with within‐individual analyses to eliminate selection bias. Findings Naltrexone combined with acamprosate [hazard ratio (HR) = 0.74; 95% confidence interval (CI) = 0.61–0.89], combined with disulfiram (HR = 0.76, 95% CI = 0.60–0.96) and as monotherapy (HR = 0.89, 95% CI = 0.81–0.97) was associated with a significantly lower risk of AUD‐hospitalization compared with no use of AUD medication. Similar results were found for risk of hospitalization due to any cause. Benzodiazepine use and acamprosate monotherapy were associated with an increased risk of AUD‐hospitalization (HR = 1.18, 95% CI = 1.14–1.22 and HR = 1.10, 95% CI = 1.04–1.17, respectively). No statistically significant effects were found for work disability or mortality. Conclusions: Naltrexone as monotherapy and when combined with disulfiram and acamprosate appears to be associated with lower risk of hospitalization due to any and alcohol‐related causes, compared with no use of alcohol use disorder (AUD) medication. Acamprosate monotherapy and benzodiazepine use appear to be associated with increased risk of AUD‐associated hospitalization. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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