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Latest research bites... in a nutshell

WHAT IS THE BACKGROUND?

Alcohol use disorders are €greatly undertreated€ and medications are €considerably underused€, researchers have found.

WHAT WAS THE METHOD?

A meta-analysis of 122 randomised controlled trials and one prospective cohort study, encompassing 22,803 people, performed between 1970 and 2014. Twenty-seven studies assessed acamprosate (7,519 participants) and 53 evaluated naltrexone (9,140), or both. Remaining studies assessed other interventions.

WHAT WERE THE FINDINGS?

The number needed to treat (NNT) to prevent one person from resuming drinking was 12 with acamprosate and 20 with oral naltrexone. The NNT to prevent one person returning to heavy drinking was 12 for oral naltrexone. Acamprosate did not significantly reduce the likelihood of returning to heavy drinking.

However, no statistically significant difference in the risk of returning to any or heavy drinking emerged between acamprosate and naltrexone. Injectable naltrexone did not reduce the risk of returning to any or heavy drinking, but cut the number of heavy drinking days by 4.6 per cent.

DRINKING DAYS DOWN

Furthermore, nalmefene and topiramate reduced the number of heavy drinking days by two per month and 9 per cent respectively and the number of drinks per drinking day by 1.02 and 1.0 respectively. Topiramate also reduced the number of drinking days by 6.5 per cent. Neither acamprosate nor topiramate increased the risk of withdrawing from the study due to adverse events. The number needed to harm (NNH) for one person to withdraw due to adverse events was 48 for naltrexone and 12 for nalmefene respectively.

WHAT WERE THE CONCLUSIONS?

Dosing frequency, potential adverse events and availability may guide the choice between acamprosate and oral naltrexone, both of which reduce the likelihood of return to drinking. Acamprosate is given three times daily, oral naltrexone once daily. Acamprosate is contraindicated in severe renal impairment, while oral naltrexone is contraindicated in acute hepatitis, liver failure, or concurrent or anticipated opioid use.

REFERENCE

Jonas DE, Amick HR, Feltner C, et al. Pharmacotherapy for adults with alcohol use disorders in outpatient settings: a systematic review and meta-analysis. JAMA 2014; 311(18):1889-1900