In spite of years of development and research and millions of dollars spent on their use, we still do not have any proof that any medications effectively reduce drinking levels of alcoholics.
Medications that have been used to try to control drinking in patients with alcohol use disorder may be effective, but there is no reliable evidence that they are effective.
Although there have been 32 double-blind, randomized controlled trials testing the effectiveness of nalmefene, naltrexone, acamprosate, baclofen or topiramate to reduce drinking among alcohol-dependent patients, there is still no clear evidence that any of them actually work.
Some Studies Showed Bias
In short, there is still no magic pill for alcoholism.
A meta-analysis of those 32 published studies, involving more than 6,000 patients, found that some of the medications did show low to medium efficacy in reducing total alcohol consumption, but those results were from studies with a high risk of bias - studies that potentially exaggerated the effects of the drugs.
None of the studies found any benefit on health outcomes or harm reduction with the use of the medications.
Incomplete Outcomes Were Common
Analysis of the studies, published between 1994 and 2015, revealed that:
- No study made direct comparisons between the drugs
- 26 studies had a risk of incomplete outcome data
- 17 studies risked selective outcome reporting
No Efficacy Found
Findings of the meta-analysis included:
- Nalmefene, baclofen and topiramate were slightly superior to a placebo on total alcohol consumption.
- No efficacy was observed for naltrexone or acamprosate.
- Topiramate was superior to nalmefene, naltrexone and acamprosate but it has a poor safety profile.
Better Studies Needed
"Although our report is based on all available data in the public domain, we did not find clear evidence of benefit of using these drugs to control drinking," the investigators concluded. "That doesn't mean the drugs aren't effective; it means we don't yet know if they are effective. To know that, we need better studies."
"Researchers urgently need to provide policy makers with evidence as to which of these drugs can be effectively translated into a real harm reduction strategy," the researchers said.
A review of recent (2017-2019) studies by Sari Castren and colleagues found three new random controlled trials on baclofen and naltrexone. "These results are consistent with old findings demonstrating that naltrexone reduces heavy drinking. Several studies on baclofen do not support the use of baclofen for treatment of alcohol use disorders. Encouraging results have been reported for topiramate, gabapentin and also varenicline, which might be useful in patients with comorbid nicotine dependence," the researchers concluded.
Curr Opin Psychiatry. 2019 Jul;32(4):266-274 While not superior to 12-step program, medical supervision (+/- Rx) compliments:
"...results are consistent with old findings demonstrating that naltrexone reduces heavy drinking. Several RCT on baclofen do not support the use of baclofen for treatment of AUD. Encouraging results have been reported for topiramate, gabapentin and also varenicline, which might be useful in patients with comorbid nicotine dependence."
Castren, S, et al. "Selecting an Appropriate Alcohol Pharmacotherapy: Review of Recent Findings." Current Opinion in Psychiatry> July 2019
Palpacuer C, et al. "Pharmacologically controlled drinking in the treatment of alcohol dependence or alcohol use disorders: a systematic review with direct and network meta-analyses on nalmefene, naltrexone, acamprosate, baclofen and topiramate." Addiction 20 September 2017
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