阿片类药物治疗不宁腿综合征患者的长期安全性、剂量稳定性和疗效:美国阿片类药物注册号:10.1212/WNL.0000000000206855DP - 2023 04月04日TA -神经半岛投注体育官网学PG - e1520—e1528 VI - 100 IP - 14 4099 - //www.ebmtp.com/content/100/14/e1520.short 4100 - //www.ebmtp.com/content/100/14/e1520.full SO -神经学2023 04月04日;背景与目的不宁腿综合征(RLS)是一种感觉-运动神经系统疾病。低剂量阿片类药物用于难治性或增强性睡眠倒睡症患者。这些药物治疗RLS的长期安全性、剂量稳定性和疗效尚不清楚。在这项研究中，我们报告了社区中接受阿片类药物治疗RLS的患者样本的2年纵向数据。方法:国家RLS阿片类药物登记处是一项观察性纵向研究，由诊断和确诊的RLS服用处方阿片类药物的个体组成，其中大多数人经历了多巴胺激动剂的增强症状。有关阿片类药物的剂量、副作用、过去和目前伴随的RLS治疗、RLS严重程度、精神症状和阿片类药物滥用危险因素的信息在最初登记时收集，此后每6个月通过REDCap调查收集一次。研究人员没有向当地提供者提供反馈或干预。结果登记的参与者(n = 448)有2年的纵向资料，大多数是白人，女性，年龄大于60岁，在登记时，服用阿片类药物的中位数为1-3年，平均吗啡毫克当量(MME)为38.4 (SD = 43.5)。 No change in RLS severity in the overall cohort was observed over the 2-year follow-up period. The median change in daily opioid dose from baseline to 2 years was 0 MME (interquartile range = 0–10). While 41.1% of participants increased their dose during the follow-up period (median increase = 10 MME), 58.9% decreased their dose or saw no change. Only 8% and 4% saw increases of >25 MME and >50 MME, respectively. Ninety-five percent of those who increased opioid dose >25 or >50 MME had one of the following features: switching opioids, discontinuation of nonopioid RLS treatment medications, at least mild insomnia at baseline, a history of depression, male sex, younger than 45 years, and opioid use for comorbid pain.Discussion Low-dose opioid medications continue to adequately control symptoms of refractory RLS over 2 years of follow-up in most of the participants. A minority of patients did see larger dose increases, which were invariably associated with a limited number of factors, most notably changes in opioid and nonopioid RLS medications and opioid use for a non-RLS condition. Continued longitudinal observations will provide insight into the long-term safety and efficacy of opioid treatment of severe, augmented RLS.Classification of Evidence This study provides Class IV evidence that opioid doses increase in roughly 40% of patients, in most by small amounts, over a 2-year period when prescribed for adult refractory restless leg syndrome.GAD-7=generalized anxiety disorder-7 scale; IRLS=International Restless Legs Syndrome Study Group Severity Scale; ISI=insomnia severity index; MDD=major depressive disorder; MME=morphine milligram equivalent; PHQ-9=Patient Health Questionnaire; RLS=restless legs syndrome; RLSF=Restless Legs Syndrome Foundation