Magazine article Clinical Psychiatry News

Acamprosate, Naltrexone Equal for Alcohol Misuse

Magazine article Clinical Psychiatry News

Acamprosate, Naltrexone Equal for Alcohol Misuse

Article excerpt

FROM JAMA

Both acamprosate and oral naltrexone are helpful for curbing alcohol use disorders, with no apparent difference in effectiveness, according to a comprehensive review of the literature and meta-analysis funded by the Agency for Healthcare Research and Quality.

When added to psychosocial interventions, acamprosate and naltrexone were helpful in preventing patients from returning to any alcohol drinking and to heavy drinking, reducing the number of days of drinking, and decreasing the number of drinks per day. Importantly, both drugs were equally beneficial for real-world health outcomes such as reducing motor vehicle crashes, decreasing all types of injuries, reducing mortality, and improving quality of life, reported Dr. Daniel E. Jonas, of the University of North Carolina at Chapel Hill, and his associates.

In contrast, disulfiram did not consistently reduce any measure of alcohol consumption or improve any alcohol-related health outcome. Clinicians might be more familiar with disulfiram "because of its long-standing availability," but the best available evidence does not support its efficacy for most patients with alcohol use disorders, the investigators said.

Dr. Jonas and his associates undertook their comprehensive report on medications for alcohol use disorders because despite their known efficacy, less than one-third of such patients receive any treatment, and less than 10% receive medication to assist in reducing alcohol consumption.

The researchers reviewed the literature and identified 151 articles examining 122 double-blind, randomized, controlled trials and 1 prospective cohort study of 12-52 weeks' duration comparing these three Food and Drug Administration-approved medications or 23 off-label medications in outpatient settings. There were 22,803 total participants, with sample sizes ranging from 21 to 1,383 subjects.

Acamprosate and oral naltrexone were comparably effective at reducing several measures of alcohol consumption. For 1 patient to be prevented from resuming any drinking, the number needed to treat was only 12 with acamprosate and only 20 for oral naltrexone. (Injectable naltrexone was not as effective.) Head-to-head comparisons of these two drugs showed no statistically significant differences between them. …

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