Data_Sheet_1_Acupuncture for Opioid Dependence Patients Receiving Methadone Maintenance Treatment: A Network Meta-Analysis.ZIP

Objectives: Opioid dependence has been a threat to public health for hundreds of years. With the increasing number of studies on acupuncture-related therapies for opioid dependence patients receiving methadone maintenance treatment (MMT), its effect of acupuncture therapy in treating MMT patients remains controversial. Therefore, we conducted a multiple-treatments meta-analysis, and incorporated both direct and indirect comparisons, in order to discover the most effective treatment for opioid dependence patients receiving MMT.
Methods: Five English databases and three Chinese databases were searched from its inception to August 20, 2020, in order to compare the effects of acupuncture-related therapies and MMT, which was summarized as Western medicine (WM) in the following texts. The quality of studies was assessed according to Cochrane's risk of bias tool 5.1.0, and a pair-wise meta-analysis, cumulative meta-analysis, and the network meta-analysis was performed using the R software (Version 3.6.1) and STATA (Version 14.0). The primary outcome was the effective rate, which was calculated by the ratio of detoxifying patients to the total. The secondary outcome was the Modified Himmelsbach Opiate Withdrawal Scale (MHOWS).
Results: A total of 20 trials were included, which consisted of comparisons among WM, traditional Chinese medicine (TCM), and the four types of acupuncture, namely, manual acupuncture (MA), electro-acupuncture (EA), auricular acupuncture (AA), and transcutaneous electrical acupoint stimulation (TEAS). Though none of the trials were at low risk of bias. In the pair-wise meta-analysis, no statistically significant differences were observed in terms of the effective rate. Furthermore, MA was more efficacious than WM, EA, and TEAS in MHOWS, with mean differences (MDs) of (−8.59, 95% CI: −15.96 to −1.23, P < 0.01), (−6.15, 95% CI: −9.45 to −2.85, P < 0.05), and (−10.44, 95% CI: −16.11 to −4.77, P < 0.05), respectively. In the network meta-analysis, MA was more effective than WM (RR: 1.40, 95% CI: 1.05 to 1.99) on the effective rate, and (MD: −5.74, 95% CI: −11.60 to −0.10) on MHOWS. TEAS was more effective than WM (MD: −15.34, 95% CI: −27.34 to −3.46) on MHOWS. Synthetically, MA had the highest probability to rank first in treating opioid dependence.
Conclusions: The existing evidence shows that acupuncture related-therapies may effectively be used for treating patients receiving MMT, and that manual acupuncture may be the best choice for opioid dependence among all kinds of acupuncture-related therapies. Nevertheless, reducing the relapse and promoting the recovery of opioid dependence need more efforts from not only the medical industry but also government support, security system, and educational popularization. To strengthen the assurance of acupuncture-related therapies in the treatment of opioid dependence, we expected that clinical trials with high quality would be conducted, to provide more confident evidence.

目的：阿片类药物依赖（opioid dependence）数百年来一直是威胁公共卫生安全的重大问题。随着针对接受美沙酮维持治疗（methadone maintenance treatment, MMT）的阿片类药物依赖患者的针灸相关疗法研究日益增多，针灸疗法对该类患者的治疗效果仍存在较大争议。为此，本研究开展了一项纳入直接与间接比较的多治疗措施Meta分析，旨在探寻针对接受美沙酮维持治疗的阿片类药物依赖患者的最优治疗方案。
方法：本研究检索了建库至2020年8月20日的5个英文数据库与3个中文数据库，以比较针灸相关疗法与西医（Western medicine, WM，下文统一简称为西医）联合美沙酮维持治疗的疗效。研究质量采用Cochrane偏倚风险评估工具5.1.0版进行评价，并使用R软件（版本3.6.1）与STATA软件（版本14.0）开展两两Meta分析、累积Meta分析及网络Meta分析。本研究的主要结局指标为有效率，以戒毒患者数占总受试者数的比值计算；次要结局指标为改良Himmelsbach阿片戒断量表（Modified Himmelsbach Opiate Withdrawal Scale, MHOWS）。
结果：最终纳入20项临床试验，涉及西医、中医（traditional Chinese medicine, TCM）以及手针疗法（manual acupuncture, MA）、电针疗法（electro-acupuncture, EA）、耳针疗法（auricular acupuncture, AA）、经皮穴位电刺激（transcutaneous electrical acupoint stimulation, TEAS）4种针灸疗法的对比。所有纳入研究均未达到低偏倚风险水平。两两Meta分析结果显示，各组间有效率无统计学显著差异。在改良Himmelsbach阿片戒断量表评分方面，手针疗法的疗效优于西医、电针疗法与经皮穴位电刺激，其均数差（mean differences, MD）分别为−8.59（95%置信区间：−15.96~−1.23，P<0.01）、−6.15（95%置信区间：−9.45~−2.85，P<0.05）与−10.44（95%置信区间：−16.11~−4.77，P<0.05）。网络Meta分析结果显示，手针疗法在有效率上优于西医（相对风险RR=1.40，95%置信区间：1.05~1.99），在改良Himmelsbach阿片戒断量表评分上亦优于西医（MD=−5.74，95%置信区间：−11.60~−0.10）；经皮穴位电刺激在改良Himmelsbach阿片戒断量表评分上优于西医（MD=−15.34，95%置信区间：−27.34~−3.46）。综合分析显示，手针疗法在治疗阿片类药物依赖的各类疗法中排名首位的概率最高。
结论：现有证据表明，针灸相关疗法可有效辅助接受美沙酮维持治疗的阿片类药物依赖患者的治疗，其中手针疗法为各类针灸相关疗法中的最优选择。然而，降低阿片类药物依赖患者的复吸率、促进其康复，不仅需要医药行业的努力，还需政府的政策支持、保障体系完善与科普教育推广。为进一步明确针灸相关疗法在阿片类药物依赖治疗中的应用价值，未来需开展高质量临床试验以提供更确凿的证据。