Evaluation of the course and treatment of Alcohol Withdrawal Syndrome with the Clinical Institute Withdrawal Assessment for Alcohol – Revised: A systematic review-based meta-analysis

Ildikó Katalin Pribék,Ildikó Kovács,Bettina Kata Kádár,Csenge Sára Kovács,Mara J Richman,Zoltán Janka,Bálint Andó,Bence András Lázár

doi:10.1016/j.drugalcdep.2021.108536

Abstract

BackgroundAlthough the Clinical Institute Withdrawal Assessment for Alcohol – Revised (CIWA-Ar) is a gold standard tool for the clinical evaluation of alcohol withdrawal syndrome (AWS), a systematic analysis using the total scores of the CIWA-Ar as a means of an objective follow-up of the course and treatment of AWS is missing. The aims of the present study were to systematically evaluate scientific data using the CIWA-Ar, to reveal whether the aggregated CIWA-Ar total scores follow the course of AWS and to compare benzodiazepine (BZD) and non-benzodiazepine (nBZD) therapies in AWS. Methods1054 findings were identified with the keyword “ciwa” from four databases (PubMed, ScienceDirect, Web of Science, Cochrane Registry). Articles using CIWA-Ar in patients treated with AWS were incorporated and two measurement intervals (cumulative mean data of day 1−3 and day 4−9) of the CIWA-Ar total scores were compared. Subgroup analysis based on pharmacotherapy regimen was conducted to compare the effectiveness of BZD and nBZD treatments. ResultsThe random effects analysis of 423 patients showed decreased CIWA-Ar scores between the two measurement intervals (BZD: d = –1.361; CI: –1.829 < δ < –0.893; nBZD: d = –0.858; CI: –1.073 < δ < –0.643). Sampling variances were calculated for the BZD (v1 = 0.215) and the nBZD (v2 = 0.106) groups, which indicated no significant group difference (z = −1.532). ConclusionsOur findings support that the CIWA-Ar follows the course of AWS. Furthermore, nBZD therapy has a similar effectiveness compared to BZD treatment based on the CIWA-Ar total scores.

Highlights

Alcohol use disorder (AUD) is a global health problem ranking sev enth among the leading causes of death (GBD 2016 Alcohol Collabora tors, 2018)
Since articles were excluded due to the lack of available CIWA-Ar means or standard deviations (N = 92), when we found an article that was potentially eligible for inclusion for our study but did not include the necessary means and standard deviations for the meta-analysis, we tried to contact the corresponding author two times over two months to ask them to provide these missing data
Comparison of the course of alcohol withdrawal syndrome (AWS) measured with the CIWA-Ar total scores in the BZD and nBZD groups

Summary

Introduction

Alcohol use disorder (AUD) is a global health problem ranking sev enth among the leading causes of death (GBD 2016 Alcohol Collabora tors, 2018). The Clinical Institute Withdrawal Assessment for Alcohol – Revised (CIWA-Ar) is a gold standard tool for the clinical evaluation of alcohol withdrawal syndrome (AWS), a systematic analysis using the total scores of the CIWA-Ar as a means of an objective follow-up of the course and treatment of AWS is missing. The aims of the present study were to systematically evaluate scientific data using the CIWA-Ar, to reveal whether the aggregated CIWA-Ar total scores follow the course of AWS and to compare benzodiazepine (BZD) and non-benzodiazepine (nBZD) therapies in AWS. Results: The random effects analysis of 423 patients showed decreased CIWA-Ar scores between the two mea surement intervals (BZD: d = –1.361; CI: –1.829 < δ < –0.893; nBZD: d = –0.858; CI: –1.073 < δ < –0.643). NBZD therapy has a similar effectiveness compared to BZD treatment based on the CIWA-Ar total scores

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Methods

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Conclusion