Oral naltrexone and acamprosate Most Effective Treatment options for Alcohol Use Disorder

A new groundbreaking study revealed that oral naltrexone at a daily dose of 50 mg and acamprosate can be recommended as the first-line pharmacotherapies for addressing alcohol use disorder along with psychosocial interventions. 

The study results were published in the journal JAMA Network. 

Alcohol use disorder is a pervasive and challenging condition affecting over 28.3 million people in the United States. It is associated with a higher incidence of health problems and mortality. In a bid to improve treatment outcomes for this condition, a comprehensive study was conducted to compare the efficacy and relative effectiveness of various therapies for alcohol use disorder. 

The research drew from many sources, including PubMed, the Cochrane Library, the Cochrane Central Trials Registry, PsycINFO, CINAHL, and EMBASE, covering November 2012 to September 9, 2022. The study then systematically monitored literature to identify relevant articles until August 14, 2023, with an update of the PubMed search on August 14, 2023.

For evaluating efficacy outcomes, the study included randomized clinical trials lasting at least 12 weeks. For assessing adverse effects, the analysis incorporated randomized clinical trials and prospective cohort studies comparing drug therapies and reporting health outcomes or harms. A comprehensive evaluation process was done that involved risk of bias assessment and the grading of the strength of evidence by two reviewers. Meta-analyses were carried out using random-effects models, and the study calculated the numbers needed to treat for medications showing at least moderate evidence of benefit.

The primary outcome of interest was alcohol consumption, while secondary outcomes encompassed motor vehicle accidents, injuries, quality of life, functional abilities, mortality, and adverse effects.

Findings: 

• The study encompassed data from 118 clinical trials involving 20,976 participants.
• Notable findings included numbers needed to treat to prevent one person from returning to any drinking, which were 11 for acamprosate and 18 for oral naltrexone at a dose of 50 mg per day.
• Compared to a placebo, oral naltrexone at 50 mg per day was linked to reduced rates of returning to heavy drinking, with the number needed to treat is 11.
• Furthermore, injectable naltrexone was associated with fewer days of drinking during a 30-day treatment period, with a weighted mean difference of -4.99 days.
• However, there were adverse effects to consider, including increased gastrointestinal distress for both acamprosate (diarrhea) and naltrexone (nausea and vomiting) compared to a placebo.

The findings of this research are expected to have a significant impact on the treatment of alcohol use disorder. The study recommends the use of oral naltrexone at a daily dose of 50 mg and acamprosate as first-line pharmacotherapies when treating this condition. These medications have demonstrated their effectiveness in helping individuals recover from alcohol dependency. The study's results come as welcome news for those struggling with alcohol use disorder, their families, and healthcare providers. Effective treatments are a crucial step in addressing this complex and challenging condition that affects millions of people in the United States.

Further reading: McPheeters M, O’Connor EA, Riley S, et al. Pharmacotherapy for Alcohol Use Disorder: A Systematic Review and Meta-Analysis. JAMA. 2023;330(17):1653–1665. doi:10.1001/jama.2023.19761