背景:阿片类药物使用与室性心律失常(VA)风险之间的关联知之甚少。
目的:本研究的目的是综合与阿片类药物使用相关的VA风险的证据。
方法:我们系统地搜索了Cochrane库,Embase,MEDLINE,2022年7月和CINAHL数据库。使用Cochrane用于随机对照试验(RCTs)的偏倚风险工具和ROBINS-I用于观察性研究的偏倚风险进行评估。使用等级评估证据的确定性。
结果:我们纳入了15项研究(12项观察性,对RCT进行2次事后分析,1RCT)。大多数研究集中在阿片类药物用于维持治疗(n=9),比较美沙酮与丁丙诺啡(n=13),并报告QTc延长(n=13)。六项观察性研究存在严重的偏倚风险,1例RCT存在高偏倚风险.两项研究无法纳入荟萃分析,因为它们报告了不同的结果并研究了阿片类药物拮抗剂。对13项研究的荟萃分析表明,与使用丁丙诺啡相比,使用美沙酮与VA风险增加相关。吗啡,安慰剂,或左乙酰美沙多(风险比[RR],2.39;95%CI,1.31-4.35;I2=60%)。观察性研究之间的汇总估计值差异很大(RR,2.12;95%CI,1.15-3.91;I2=62%)和RCT(RR,14.09;95%CI,1.52-130.61;I2=0%),但两者都表明风险增加。
结论:在本系统综述和荟萃分析中,我们发现,美沙酮的使用与对照组相比,VA的风险是前者的两倍多.然而,鉴于现有证据的质量有限,我们的研究结果应谨慎解释.
BACKGROUND: The association between opioid use and the risk of ventricular arrhythmias (VA) is poorly understood.
OBJECTIVE: The objective of this study was to synthesize the evidence on the risk of VA associated with opioid use.
METHODS: We systematically searched the Cochrane Library, Embase, MEDLINE, and CINAHL databases in July 2022. Risk of bias was assessed using the Cochrane risk for bias tool for randomized controlled trials (RCTs) and ROBINS-I for observational studies. Certainty of evidence was assessed using GRADE.
RESULTS: We included 15 studies (12 observational, 2 post hoc analyses of RCTs, 1 RCT). Most studies focused on opioid use for maintenance therapy (n = 9), comparing methadone to buprenorphine (n = 13), and reported QTc prolongation (n = 13). Six observational studies had a critical risk of bias, and one RCT was at high risk of bias. Two studies could not be included in the meta-analysis as they reported a different outcome and studied an opioid antagonist. Meta-analysis of 13 studies indicated that the use of methadone was associated with an increased risk of VA compared to the use of buprenorphine, morphine, placebo, or levacetylmethadol (risk ratio [RR], 2.39; 95% CI, 1.31-4.35; I2 = 60%). The pooled estimate varied greatly between observational studies (RR, 2.12; 95% CI, 1.15-3.91; I2 = 62%) and RCTs (RR, 14.09; 95% CI, 1.52-130.61; I2 = 0%), but both indicated an increased risk.
CONCLUSIONS: In this systematic review and meta-analysis, we found that methadone use is associated with more than twice the risk of VA compared to comparators. However, our findings should be interpreted cautiously given the limited quality of the available evidence.