Effectiveness of Medicines to Treat Alcohol Use Disorders

alcohol use disordersA recent analysis of more than 120 studies that examined the effectiveness of medicines to treat alcohol use disorders found that acamprosate and oral naltrexone have the strongest evidence for decreasing alcohol consumption.[1]

Alcohol use disorders (AUDs) are too common, causing serious illnesses and increasing the risk of early death by three times.1 Treating AUDs is difficult; however, when treated with medicine, many do well.1 Unfortunately, less than 10 percent of patients with AUDs receive medicine to assist in reducing alcohol consumption.1

Daniel E. Jonas, MD, MPH, and colleagues of the University of North Carolina conducted a review and meta-analysis to evaluate both the benefits and harms of medicines that are used for the treatment of adults with AUDs.1 Overall, the researchers identified 122 randomized clinical trials and one cohort study, giving a total of 22,803 participants.1

Most of the studies assessed acamprosate, naltrexone, or both.1 The researchers presented their results in terms of number needed to treat (NNT), which is the average number of patients who needed to be treated to see benefit in one patient.1 The NNT to prevent return to any drinking for acamprosate was 12, and the NNT for oral naltrexone was 20.1 The NNT to prevent return to heavy drinking was 12 for oral naltrexone.1

For injectable naltrexone, the researchers did not find an association with return to any drinking or heavy drinking, but found an association with reduction in heavy drinking days.1 Also, due to its long-standing availability, clinicians may be more familiar with disulfiram, rather than naltrexone or acamprosate.1 However, researchers found that disulfiram does not adequately support an association with preventing return to any drinking or improvement in other alcohol consumption outcomes.1

Among medications that are used off-label, the researchers found moderate evidence that supports an association with improvement in some consumption outcomes for nalmefene and topiramate.1

“When clinicians decide to use one of the medications, a number of factors may help with choosing which medication to prescribe, including the medication’s efficacy, administration frequency, cost, adverse events, and availability,” the researchers concluded.1

Katharine A. Bradley, MD, MPH of the Group Health Research Institute, Seattle, and Daniel R. Kivlahan, PhD, of the Veterans Health Administration, Washington, D.C., commented on the findings in an editorial:

“Treatment of AUD is considered an essential health benefit under health care reform. More patients with AUDs will have insurance, which could increase their access to evidence-based treatments for AUDs. The article by Jonas and colleagues should encourage patients and their clinicians to engage in shared decision making about AUD treatment options. By identifying 4 effective medications for AUD [naltrexone, acamprosate, topiramate, and nalmefene], the authors highlight treatment options for a common medical condition for which patient-centered care is not currently the norm. Patients with AUDs should be offered options, including medications, evidence-based behavioral treatments, and mutual support for recovery. Moreover, patients should expect shared decision making about the best options for them.”1

[1] The JAMA Network Journals. (2014, May 13). Effectiveness of medications to treat alcohol use disorders examined. ScienceDaily. Retrieved May 16, 2014 from www.sciencedaily.com/releases/2014/05/140513161720.htm

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