Clinical and Economic Evaluation of Acupuncture for Opioid-Dependent Patients Receiving Methadone Maintenance Treatment: The Integrative Clinical Trial and Evidence-Based Data

The effectiveness and safety of herbal medicine on suicidal behavior: A PRISMA-compliant systematic review and meta-analysis

BACKGROUND

Suicide is the leading cause of death worldwide. Herbal medicine (HM) has been reported to be related to clinical improvement of some risk factors for suicide including depression. This systematic review aimed to comprehensively investigate the effectiveness and safety of HM on suicidal behaviors.

METHODS

Fifteen electronic databases were searched to search relevant intervention studies, up to September 2022. The methodological quality of the included studies was assessed using the modified Cochrane risk-of-bias tool. In the included studies, outcome on suicidal behavior were analyzed, and the effect sizes were presented as mean differences (MDs) or risk ratios (RRs) with their 95% confidence intervals (CIs) through meta-analysis. The strength of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.

RESULTS

A total of 13 randomized controlled trials (RCTs) were included in this review. Two RCTs of HM in patients with suicidal behavior found significant benefits of HM as an adjunct to fluoxetine or cognitive therapy in improving symptoms of depression. In 11 RCTs of HM in patients with other conditions, there was no statistically significant difference between HM and antidepressants in cognitive disturbance (MD, 0.12; 95% CIs, -0.20 to 0.45), a subscale of the Hamilton Rating Scale for Depression (HAMD), and suicidal ideation (0.18; -0.16 to 0.53), an item of HAMD. The overall quality of the included studies was poor. The strength of evidence assessed by GRADE was low or very low.

CONCLUSIONS

Though some of the studies reported significant benefits of HM in improving suicidal behavior in patients with depression, further clarification on some unsolved questions is needed in future well-designed clinical trials.

Acupuncture-related therapies for protracted opioid abstinence syndrome:A systematic review and meta-analysis

Background

An increasing amount of clinical evidence of acupuncture's effect on protracted opioid abstinence syndrome (POAS) has emerged in recent years. The aim of this study was to evaluating the evidence of efficacy of acupuncture for POAS. clinical and scientific research work.

Methods

Four English-language databases (PubMed, Medline, Embase, Cochrane Libraries) and three Chinese-language databases (CNKI, WanFang and VIP Libraries) were searched, with coverage from database inception to March 31, 2022. Randomized clinical trials (RCTs) evaluating the effects of acupuncture and acupuncture-related therapies for prophylaxis or treatment of POAS were included. Data were screened and extracted independently according to pre-set tabular formats. RCT quality was assessed using risk of bias tool in the Cochrane Collaboration. The primary outcome was opiate withdrawal scale. The secondary outcomes are depression, anxiety for assessing protracted symptoms. The scores on the above scales are proportional to the severity of the symptoms.

Results

Twenty-eight trials met the inclusion criteria and provided data for the meta-analysis. A total of only 3 studies (11%) were judged to be low-risk overall due to various biases in them. Acupuncture-related therapy showed statistical differences in improving protracted withdrawal symptom scores compared with sham acupuncture (5 studies, Standard mean difference (SMD), -1.85, 95% CI [-3.21, -0.50], P = 0.007), western medicine(7 studies, SMD, -0.72, 95% CI [-1.22, -0.21], P = 0.005)and no treatment(3 studies, SMD,-2.26, 95% CI [-3.82, -0.69], P = 0.005)with high heterogeneity.

Conclusions

Acupuncture maybe safe and effective in relieving POAS individuals' protracted withdrawal symptoms. However, the results of our review should be interpreted with caution because of the high risk of bias of the included trials.

Study registration

The protocol of this review has been registered at PROSPERO (CRD42022335505).

A protocol for the integration of multi-omics bioinformatics: Mechanism of acupuncture as an adjunctive therapy for alcohol use disorder

Background

Alcohol use disorder (AUD) has become a significant global factor in various diseases. As a non-pharmacological therapy, certain therapeutic potential has been found in acupuncture; however, in-depth mechanistic studies related to acupuncture for patients with AUD are still insufficient.

Methods

Based on a randomized control design and a multi-omics analysis plan, this protocol details the recruitment (42 AUD patients), group allocation (21 in acupuncture group vs. 21 in sham acupuncture group), intervention and follow-up (replacement drugs as a normal treatment, 2 weeks acupuncture duration, and 3 month follow-up), and data collection and analytical processes. For the clinical outcomes, in addition to the time required for alcohol withdrawal symptoms to subside as the primary outcome, changes in the alcohol withdrawal symptoms, alcohol craving, mood dysfunction, sleep disorder, fatigue, self-efficacy, gastrointestinal symptoms, the quality of life, and the relapse outcomes will be compared between the groups to confirm the acupuncture clinical effectiveness on alcohol withdraw. The gut microbiome and the fecal metabolomics will also be assessed to explore the association of the structure and the function of gut microflora and the mediation of acupuncture effect on AUD fully utilizing gut microflora multi-modal data and clinical information, via the combination of multi-omics methods, feature screening algorithms and appropriate models.

Discussion

The results of this study may help to strengthen clinical evidence of the mechanism of acupuncture intervention in patients with AUD, through understanding of the regulatory mechanism of acupuncture in the gut microbiome and its metabolism as well as AUD-related clinical manifestations.

Trial registration

Chinese Clinical Trial Registry ChiCTR2200058120. Registered on 24 Mar 2022.

Decision tree model based prediction of the efficacy of acupuncture in methadone maintenance treatment

Background

Patients with MMT often face difficulties such as sleep disturbance, headaches, and difficulty in complete abstinence from drugs. Research has shown that acupuncture can mitigate side effects while attenuating methadone dependence. It also has a synergistic and attenuated effect on methadone maintenance treatment (MMT). Exploring the predictors of the efficacy of acupuncture intervention in MMT might help clinicians and patients promote acupuncture-assisted participation in MMT, and improve clinical treatment strategies for MMT.

Objective

To describe the effect of potential predictors on MMT after acupuncture intervention by building a decision-tree model of data from A Clinical Study of Acupuncture-assisted MMT.

Design, setting, and participants

In this randomized controlled trial, 135 patients with MMT underwent acupuncture at the Substance Dependence Department of Guangzhou Huiai Hospital in Guangzhou, Guangdong Province, China.

Intervention

A total of 135 patients were 1:1 randomly assigned to either an acupuncture plus routine care group (acupuncture plus methadone) or a routine group (methadone only) for 6 weeks, and followed up for 10 weeks. Sex, age, education level, route of previous opioid use, years of opioid use, and MMT time were recorded before the trial.

Outcome measurements and statistical analysis

All analyses were based on the intention-to-treat (ITT) population. The two decision tree models used the change of methadone dosage and the VAS score for opioid desire as response variables, respectively, and the evaluation criteria were positive effect (decreased by ≥20%) and no effect (decreased by <20%, or increased). We generated the respective feature weights for the decision tree and evaluated the model's accuracy and performance by Precision-Recall.

Results

The overall accuracy of methadone reduction and psychological craving VAS scoring decision trees were 0.63 and 0.74, respectively. The Methadone Dosage Efficacy decision tree identified years of opioid use (weight = 0.348), acupuncture (weight = 0.346), and route of previous opioid use (weight = 0.162) as key features. For the VAS Score decision tree, acupuncture (weight = 0.618), MMT time (weight = 0.235), and age (weight = 0.043) were the important features.

Conclusion

Exploratory decision tree analysis showed that acupuncture, years of opioid use, route of previous opioid use, MMT time, and age were key predictors of the MMT treatment. Thus, acupuncture-assisted MMT strategy should consider the relevant influencing factors mentioned above.

Patient summary

Understanding patient characteristics and the impact of acupuncture regimens on methadone dosage reduction in MMT patients may help physicians determine the best treatment regimen for patients. An analysis of data from our clinical trial showed that acupuncture, years of opioid use, route of previous opioid use, age, and MMT time were key predictors of progressive recovery in patients with MMT. Eligible patients may benefit most from the MMT rehabilitation that reduces consumption and psychological cravings for methadone.

Clinical trial registration

http://www.chictr.org.cn/index.aspx, identifier: ChiCTR1900026357.

Acupuncture for Opioid Dependence Patients Receiving Methadone Maintenance Treatment: A Network Meta-Analysis

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.