There is no magic pill to cure alcoholism, according to a scientific review of the evidence of five drugs being prescribed by doctors. None of the available drugs namely nalmefene, naltrexone, acamprosate, baclofen or topiramate was effective for pharmacological treatment to control drinking.Dr Clément Palpacuer from Inserm, the French National Institute of Health and Medical Research and his associates looked at the trials carried out on nalmefene, naltrexone, acamprosate, baclofen and topimarate against placebos to reach this conclusion.
In a systematic review with direct and network meta-analysis of double-blind randomized controlled trials the researchers explored the comparative effectiveness of drugs used for Pharmacologically controlled drinking in the treatment of alcohol dependence or alcohol use disorders (AUDs) . It was found that none of the five drugs has a body of reliable evidence behind it for the same.
In the meta-analysis of double-blind randomized controlled trials (RCTs) Clement Palpacuer et al. assessed the efficacy of nalmefene, naltrexone, acamprosate, baclofen or topiramate in non-abstinent adults diagnosed with alcohol dependence or AUDs. Two independent reviewers selected published and unpublished studies on Medline, the Cochrane Library, Embase, ClinicalTrials.gov, contacted pharmaceutical companies, the European Medicines Agency and the Food and Drug Administration, and extracted data.In all Thirty-two RCTs were included in trial and a total of 6036 patients participated in it .The primary outcome was total alcohol consumption (TAC).It was found that no study provided direct comparisons between drugs. A risk of incomplete outcome data was identified in 26 studies (81%) and risk of selective outcome reporting in 17 (53%). Nalmefene [standardized mean difference (SMD) = −0.19, 95% confidence interval (CI) = −0.29, –0.10; I2 = 0%], baclofen (SMD = −1.00, 95% CI = −1.80, −0.19; one study) and topiramate (SMD = −0.77, 95% CI = −1.12, –0.42; I2 = 0%) showed superiority over placebo on TAC. No efficacy was observed for naltrexone or acamprosate. Similar results were observed for other consumption outcomes, except for baclofen (the favourable outcome on TAC was not reproduced). The number of withdrawals for safety reasons increased under nalmefene and naltrexone. No treatment demonstrated any harm reduction (no study was powered to explore health outcomes). Indirect comparisons suggested that topiramate was superior to nalmefene, naltrexone and acamprosate on consumption outcomes, but its safety profile is known to be poor.
The researchers concluded that there is currently no high-grade evidence for pharmacological treatment to control drinking using nalmefene, naltrexone, acamprosate, baclofen or topiramate in patients with alcohol dependence or alcohol use disorder. Some treatments show low to medium efficacy in reducing drinking across a range of studies with a high risk of bias. None demonstrates any benefit on health outcomes.
A Medical practitioner with a flair for writing medical articles, Dr Kamal Kant Kohli joined Medical Dialogues as an Editor-in-Chief for the Speciality Medical Dialogues. Before Joining Medical Dialogues, he has served as the Hony. Secretary of the Delhi Medical Association as well as the chairman of Anti-Quackery Committee in Delhi and worked with other Medical Councils of India. Email: email@example.com. Contact no. 011-43720751
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