Acamprosate helps maintain alcohol abstinence in primary care: BMJ
UK: Other than acamprosate, there is a lack of evidence that substantiate the benefits from interventions that could be implemented in primary care settings for alcohol abstinence. According to the study, published in the journal BMJ, acamprosate was found to be the only intervention that had enough high quality evidence that made the authors to conclude that it is better at maintaining alcohol abstinence than placebo.
There is an accumulating evidence for the role of several interventions for maintaining abstinence in primary care settings. In this systematic review and network meta-analysis by Hung-Yuan Cheng, senior research associate, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK, and colleagues aimed to determine the most effective interventions for alcohol abstinence with the potential to be delivered in a primary care setting.
The researchers searched the online databases for randomized controlled trials comparing two or more interventions that could be used in primary care. It included patients with alcohol dependency diagnosed by standardized clinical tools and who became detoxified within four weeks. A total of 64 trials consisting of 43 interventions were included.
Key findings of the study include:
- The median probability of abstinence across placebo arms was 25%.
- Compared with placebo, the only intervention associated with increased probability of abstinence and moderate certainty evidence was acamprosate (odds ratio 1.86 corresponding to an absolute probability of 38%).
- Of the 62 included trials that reported all cause dropouts, interventions associated with a reduced number of dropouts compared with placebo (probability 50%) and moderate certainty of evidence were acamprosate (0.73, 0.62 to 0.86; 42%), naltrexone (0.70, 0.50 to 0.98; 41%), and acamprosate-naltrexone (0.30, 0.13 to 0.67; 17%).
- Acamprosate was the only intervention associated with moderate confidence in the evidence of effectiveness and acceptability up to 12 months.
- It is uncertain whether other interventions can help maintain abstinence and reduce dropouts because of low confidence in the evidence.
"These findings have important implications for clinical practice, as acamprosate was found to be the only intervention with enough high quality evidence for us to conclude that it is better at maintaining alcohol abstinence than placebo," wrote the authors.
"The finding that there is currently little evidence on other interventions, such as disulfiram, for detoxified, alcohol dependent patients in UK primary care settings should lead to the generation of better evidence from high quality pragmatic randomised trials," they concluded.
"Treatment interventions to maintain abstinence from alcohol in primary care: systematic review and network meta-analysis," is published in the journal BMJ.
DOI: https://www.bmj.com/content/371/bmj.m3934
