Evidence map›Paper›PMID 33239318›Full record

SynthesisBMJ (Clinical research ed.)2020

Treatment interventions to maintain abstinence from alcohol in primary care: systematic review and network meta-analysis.

Hung-Yuan Cheng, Luke A McGuinness, Roy G Elbers, Georgina J MacArthur, Abigail Taylor, Alexandra McAleenan, Sarah Dawson, José A López-López, Julian P T Higgins, Sean Cowlishaw and 3 more

Open access · hybridAbstract readSystematic ReviewNetwork Meta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in BMJ (Clinical research ed.), 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 31 papers, 7 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
31citing papers in PubMed, 7 pooled it
6.8field-weighted citation impact, top 2% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

31 citing papers in PubMed, 7 syntheses or guidelines pooled it, 73 citations in OpenAlex.

  1. Pooled it
  2. Guideline
  3. Canadian guideline for the clinical management of high-risk drinking and alcohol use disorder.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2023
    Guideline
  4. Pooled it
  5. Pooled it
  6. Pooled it
  7. Genetic contributions to alcohol use disorder treatment outcomes: a genome-wide pharmacogenomics study.Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology · 2021
    Pooled it
  8. Trial
  9. Trial
  10. Trial
  11. Trial
  12. Article
  13. Article
  14. Article
  15. Review
  16. Observational
  17. CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2024
    Article
  18. Review
  19. Article
  20. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

13 authors at 4 institutions in 3 countries.

Hung-Yuan ChengPopulation Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
Luke A McGuinnessPopulation Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
Roy G ElbersPopulation Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
Georgina J MacArthurPopulation Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
Abigail TaylorPopulation Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
Alexandra McAleenanPopulation Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
Sarah DawsonPopulation Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
José A López-LópezPopulation Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
Julian P T HigginsPopulation Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
Sean CowlishawPopulation Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
Anne Lingford-HughesFaculty of Medicine, Department of Brain Sciences, Imperial College London, London, UK.
Matthew HickmanPopulation Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
David KesslerPopulation Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK david.kessler@bristol.ac.uk.ORCID 0000-0001-5333-132X
University of Bristol · GBUniversity Hospitals Bristol NHS Foundation Trust · GBImperial College London · GBThe University of Melbourne · AU

Funding

Department of Health DRF-2018-11-ST2-048Medical Research Council MR/N00616X/1
6 · The paper itself

Abstract

objectiveTo determine the most effective interventions in recently detoxified, alcohol dependent patients for implementation in primary care.

designSystematic review and network meta-analysis. DATA SOURCES: Medline, Embase, PsycINFO, Cochrane CENTRAL, ClinicalTrials.gov, and the World Health Organization's International Clinical Trials Registry Platform. STUDY SELECTION: Randomised controlled trials comparing two or more interventions that could be used in primary care. The population was patients with alcohol dependency diagnosed by standardised clinical tools and who became detoxified within four weeks. DATA EXTRACTION: Outcomes of interest were continuous abstinence from alcohol (effectiveness) and all cause dropouts (as a proxy for acceptability) at least 12 weeks after start of intervention.

results64 trials (43 interventions) were included. The median probability of abstinence across placebo arms was 25%. Compared with placebo, the only intervention associated with increased probability of abstinence and moderate certainty evidence was acamprosate (odds ratio 1.86, 95% confidence interval 1.49 to 2.33, corresponding to an absolute probability of 38%). Of the 62 included trials that reported all cause dropouts, interventions associated with a reduced number of dropouts compared with placebo (probability 50%) and moderate certainty of evidence were acamprosate (0.73, 0.62 to 0.86; 42%), naltrexone (0.70, 0.50 to 0.98; 41%), and acamprosate-naltrexone (0.30, 0.13 to 0.67; 17%). Acamprosate was the only intervention associated with moderate confidence in the evidence of effectiveness and acceptability up to 12 months. It is uncertain whether other interventions can help maintain abstinence and reduce dropouts because of low confidence in the evidence.

conclusionsEvidence is lacking for benefit from interventions that could be implemented in primary care settings for alcohol abstinence, other than for acamprosate. More evidence from high quality randomised controlled trials is needed, as are strategies using combined interventions (combinations of drug interventions or drug and psychosocial interventions) to improve treatment of alcohol dependency in primary care. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42016049779.

Indexed as

AdultAlcohol AbstinenceAlcoholismBehavior TherapyFemaleHumansMaleMiddle AgedPrimary Health CareRandomized Controlled Trials as TopicTreatment Outcome

Identifiers

PMID33239318
PMCPMC7687021
OpenAlexW3110055555

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.