There is a need to increase the armamentarium of pharmacotherapies for alcohol use disorder (AUD). Recent research suggests that mineralocorticoid receptor (MR) antagonism via spironolactone may represent a novel pharmacological treatment for AUD. We conducted a pharmacoepidemiologic retrospective cohort study (June 1, 2014 to May 31, 2018) to examine whether spironolactone dispensation (≥90 continuous days), for any indication, is associated with changes in weekly alcohol use about 6 months later. We compared 523 spironolactone-treated adults and 2305 untreated adults, matched on high-dimensional propensity scores created from a set of predefined (sociodemographic and health characteristics, diagnoses, and service utilization) and empirical electronic health record-derived covariates. The sample was 57% female and 27% non-White with a mean age of 59.2 years (SD = 19.3). Treated patients reduced their weekly alcohol use by 3.50 drinks (95% CI = −4.22, −2.79), while untreated patients reduced by 2.74 drinks (95% CI = −3.22, −2.26), yielding a significant difference of 0.76 fewer drinks (95% CI = −1.43, −0.11). Among those who drank >7 drinks/week at baseline, treated patients, compared to untreated patients, reported a greater reduction in weekly alcohol use by 4.18 drinks (95% CI = −5.38, −2.97), while there was no significant difference among those who drank less. There was a significant dose-response relationship between spironolactone dosage and change in drinks/week. Pending additional evidence on its safety and efficacy in individuals with AUD, spironolactone (and MR blockade, at large) may hold promise as a pharmacotherapy for AUD.

有必要增加针对酒精使用障碍 (AUD) 的药物疗法的设备。最近的研究表明，通过螺内酯拮抗盐皮质激素受体 (MR) 可能代表了一种新的 AUD 药物治疗。我们进行了一项药物流行病学回顾性队列研究（2014 年 6 月 1 日至 2018 年 5 月 31 日），以检查螺内酯分配（≥90 连续天）是否与大约 6 个月后每周饮酒量的变化有关。我们比较了 523 名接受螺内酯治疗的成人和 2305 名未接受治疗的成人，根据一组预定义的（社会人口学和健康特征、诊断和服务利用）和经验性电子健康记录衍生的协变量创建的高维倾向得分进行匹配。样本为 57% 的女性和 27% 的非白人，平均年龄为 59.2 岁（SD = 19.3）。接受治疗的患者每周饮酒量减少了 3.50 杯（95% CI = -4.22，-2.79），而未接受治疗的患者减少了 2.74 杯（95% CI = -3.22，-2.26），两者之间的差异显着减少了 0.76 杯（ 95% CI = -1.43，-0.11）。在基线时每周饮酒超过 7 杯的患者中，接受治疗的患者与未接受治疗的患者相比，每周饮酒量减少了 4.18 杯（95% CI = -5.38，-2.97），而两者之间没有显着差异喝得少的人。螺内酯剂量与每周饮酒量变化之间存在显着的剂量反应关系。等待更多证据证明其在 AUD、螺内酯（和 MR 阻滞剂）患者中的安全性和有效性，