很多人都說發meta分析就是“灌水”，但是這次介紹的文章還敢說是“灌水”嗎？當然，能夠發表在這種期刊上的人肯定不會缺文章，更不會擔心畢業問題和評職稱問題。這次介紹的文章發表在BMJ上，影響因子：30，醫學四大名刊之一。

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

1

研究目的

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

2

研究方法

Design Systematic 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.

3

研究結果

64 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.

4

研究結論

Evidence 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.

整個流程跟普通網狀meta分析一個樣，都是文獻檢索、文獻篩選、質量評估、資料提取、資料合併。

文章的亮點之處：

1、idea比較新穎（meta分析的靈魂核心之處）

2、納入的試驗資料充足，可分析性強

3、圖片非常漂亮（不知道用什麼鬼畫）

4、走規範流程，進行相關注冊

5、工作量巨大，完成周期長

（起碼要一年半載，而國內很多的meta一個星期就出一篇）