Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 May;119(5):815-832.
doi: 10.1111/add.16421. Epub 2024 Jan 3.

Efficacy and safety of alcohol reduction pharmacotherapy according to treatment duration in patients with alcohol dependence or alcohol use disorder: A systematic review and network meta-analysis

Kazumasa Kotake  1   2 , Tomonari Hosokawa  3 , Masuo Tanaka  3 , Ryuhei So  2   4 , Masahiro Banno  2   5   6 , Yuki Kataoka  2   7   8   9 , Akihiro Shiroshita  2   10 , Yasuhiko Hashimoto  11
Affiliations

Efficacy and safety of alcohol reduction pharmacotherapy according to treatment duration in patients with alcohol dependence or alcohol use disorder: A systematic review and network meta-analysis

Kazumasa Kotake et al. Addiction. 2024 May.

Abstract

Background and aims: Relapse is common in alcohol dependence (AD) and alcohol use disorder (AUD), so alcohol reduction therapy should be measured over as long a period as possible; however, existing reviews do not consider the duration of treatment and therefore alcohol reduction therapy may not have been appropriately evaluated. This review evaluated the efficacy and safety of alcohol reduction pharmacotherapy in patients with AD or AUD according to the duration of treatment.

Methods: We conducted a systematic review and network meta-analysis of randomized controlled trials (RCTs) that assessed 15 pharmacological agents. MEDLINE, Embase, PsycINFO, the Cochrane Central Register of Controlled Trials, the ClinicalTrials.gov and the International Clinical Trials Registry Platform were searched for eligible trials through to May 2021. Outcomes were heavy drinking days (HDD), total alcohol consumption (TAC), any adverse event and days without drinking.

Results: Fifty-five RCTs (n = 8891) were included. Nalmefene was superior to placebo for reducing HDD (standard mean difference [SMD] -0.28, 95% confidence interval [CI] -0.37, -0.18) and TAC (SMD -0.25, 95% CI -0.35, -0.16) in the long-term, but not in the short-term. Topiramate was superior to placebo for reducing HDD (SMD -0.35, 95% CI -0.59, -0.12) and days without drinking (SMD 0.46, 95% CI 0.11, 0.82), and baclofen was superior for reducing TAC (SMD -0.70, 95% CI -1.29, -0.11), in the short-term. The frequency of adverse events was higher with nalmefene and topiramate than with placebo.

Conclusion: Nalmefene, topiramate and baclofen may be effective as alcohol reduction pharmacotherapy; however, only nalmefene has demonstrated long-term efficacy, and nalmefene and topiramate have a significantly higher frequency of adverse events compared with placebo.

Keywords: alcohol dependence; alcohol reduction pharmacotherapy; alcohol use disorder; network meta‐analysis; systematic review; treatment duration.

PubMed Disclaimer

References

REFERENCES

    1. Alcohol [Internet]. [cited 2023 Mar 11]. Available from: https://www.who.int/news-room/fact-sheets/detail/alcohol
    1. Hasin DS, Stinson FS, Ogburn E, Grant BF. Prevalence, correlates, disability, and comorbidity of DSM‐IV alcohol abuse and dependence in the United States: results from the National Epidemiologic Survey on alcohol and related conditions. Arch Gen Psychiatry. 2007;64(7):830–842. https://doi.org/10.1001/archpsyc.64.7.830
    1. Rehm J, Shield KD, Gmel G, Rehm MX, Frick U. Modeling the impact of alcohol dependence on mortality burden and the effect of available treatment interventions in the European Union. Eur Neuropsychopharmacol. 2013;23(2):89–97. https://doi.org/10.1016/j.euroneuro.2012.08.001
    1. Chartier KG, Miller K, Harris TR, Caetano R. A 10‐year study of factors associated with alcohol treatment use and non‐use in a U.S. population sample. Drug Alcohol Depend. 2016;160:205–211. https://doi.org/10.1016/j.drugalcdep.2016.01.005
    1. Wallhed Finn S, Bakshi A‐S, Andréasson S. Alcohol consumption, dependence, and treatment barriers: perceptions among nontreatment seekers with alcohol dependence. Subst Use Misuse. 2014;49(6):762–769. https://doi.org/10.3109/10826084.2014.891616

Publication types

LinkOut - more resources