Second-line Pharmacological Treatments for Alcohol Withdrawal Syndrome in Hospitalized Adults : A Systematic Literature Review and Network Meta-analysis

ABSTRACT: Background: Our objective was to determine the best second-line pharmacological treatment option for alcohol withdrawal syndrome (AWS). Methods: We searched five electronic databases and gray literature for randomized clinical trials comparing benzodiazepines versus second-line pharmacological options associated with benzodiazepines and assessing CIWA-Ar at 24, 48, or 72 hours and/or benzodiazepine dose required for clinical stabilization at 24, 48, 72 hours, or during total hospitalization. We conducted network meta-analysis (NMA) using frequentist random-effects models and calculated mean differences with 95% confidence intervals (CI). Results: We included 8 clinical trials (N=300) and grouped them according to the time of outcome assessment. We plotted a total of 3 networks for the CIWA-Ar outcome and 4 networks for the outcome of benzodiazepine required dose. CIWA-Ar at 24 hours (N=153): Oxytocin (MD = -3.9; 95% CI -11.12; 3.33), Baclofen (MD = -1.1; 95% CI -11.23; 9.03), Pregabalin (MD = -0.6; 95% CI -1.71; 9.51), with very low certainty of the evidence. Benzodiazepine dose required for clinical stabilization (N=171): Dexmedetomidine 1.2 mcg/kg/min (MD: -53.5; 95% CI -153.89; 46.89), Dexmedetomidine 0.4 mcg/kg/min (MD: -50.6; 95% CI -88.16; -13.04), Oxytocin (MD: -7.00 (-18.39; 4.38), Divalproex (MD: -1.7 (17.77; 14.37), and Baclofen (MD: 2; 95% CI -13.61; 17.61), with very low certainty of the evidence. Conclusions: This NMA found no statistically significant differences in the primary outcome. However, suggests that alpha-2 agonists could be considered as an option in patients who have not adequately responded to benzodiazepine management, have contraindications for their use, or have difficult access to them.

• Autores: Franco Otero, Daniela; Mesa Tobón, Laura María
• Tipo de recurso: Tesis
• Fecha de publicación: 2024
• Institución: Universidad de Antioquia
• Repositorio: Repositorio UdeA
• Idioma: eng
• OAI Identifier: oai:bibliotecadigital.udea.edu.co:10495/42369
• Acceso en línea: https://hdl.handle.net/10495/42369
• Palabra clave: Síndrome de abstinencia a sustancias; Substance withdrawal syndrome; Quimioterapia; Drug therapy; Clonidina; Clonidine; Dexmedetomidina; Dexmedetomidine; Agonistas de receptores adrenérgicos alfa 2; Adrenergic alpha-2 receptor agonists; Metaanálisis en red; Network meta-analysis; https://id.nlm.nih.gov/mesh/D013375; https://id.nlm.nih.gov/mesh/D004358; https://id.nlm.nih.gov/mesh/D003000; https://id.nlm.nih.gov/mesh/D020927; https://id.nlm.nih.gov/mesh/D058647; https://id.nlm.nih.gov/mesh/D000071076
• Rights: openAccess
• License: http://creativecommons.org/licenses/by-nc-sa/2.5/co/