Jennifer McNeely, MD, MS; Scott Sherman, MD, MPH
Is acamprosate better then placebo or other drugs for reducing return to drinking and increasing duration of abstinence in patients with alcohol dependence?
Included studies compared acamprosate, alone or combined with other therapies, with placebo or other drugs given for ≥ 4 weeks in patients with alcohol dependence (Diagnostic and Statistical Manual of Mental Disorders or International Statistical Classification of Diseases criteria). Studies that also included patients with alcohol abuse were included only if > 50% of patients had alcohol dependence. Outcomes included return to drinking, duration of abstinence, and adverse effects.
MEDLINE, EMBASE/Excerpta Medica, and CINAHL (to Jan 2009); Cochrane Central Register of Controlled Trials (Cochrane Library, 2009, Issue 2); clinical trial registries; and reference lists were searched for double-blind, parallel-design, randomized controlled trials (RCTs). Experts and the drug manufacturer, Merck Serono, were contacted. 24 RCTs (n = 6915) met the selection criteria: 23 included adults only (median age 42 y, 68% to 100% men) and 1 included adolescents (mean age 17 y, 65% men). In 23 RCTs, patients had completed detoxification and had ≥ 3 days of continuous abstinence. Treatment duration ranged from 8 weeks to 12 months, 10 RCTs reported posttreatment follow-up for drinking-related outcomes (range 12 wk to 12 mo), and 23 RCTs were in outpatient settings. All RCTs included psychosocial treatment; 16 provided information about the treatments.
Meta-analysis showed that acamprosate reduced return to drinking and increased duration of abstinence more than placebo (Table); acamprosate and naltrexone did not differ (Table). Diarrhea was more frequent with acamprosate than placebo or naltrexone (Table). Nausea was less frequent with acamprosate than naltrexone (3 RCTs, n = 800, relative risk reduction 29%, 95% CI 9 to 45); acamprosate and placebo did not differ.
In patients with alcohol dependence, acamprosate reduces the proportion of persons who return to drinking and increases duration of abstinence more than placebo.
Acamprosate vs placebo or naltrexone in patients with alcohol dependence*
*NS = not significant; other abbreviations defined in Glossary. RRR, RRI, NNT, NNH, and CI calculated from data in article using a random-effects model.
†Reported as n = 8972 in the original review; however, each trial was included twice in that analysis.
McNeely J, Sherman S. Review: Acamprosate increases abstinence in patients with alcohol dependence. Ann Intern Med. ;154:JC1–10. doi: 10.7326/0003-4819-154-2-201101180-02010
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Published: Ann Intern Med. 2011;154(2):JC1-10.
Tobacco, Alcohol, and Other Substance Abuse.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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