Document Detail

Opioid antagonists for alcohol dependence.
MedLine Citation:
PMID:  21154349     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Alcohol dependence belongs to the globally leading health risk factors. Therapeutic success of psychosocial programs for relapse prevention is moderate and could be increased by an adjuvant treatment with the opioid antagonists naltrexone and nalmefene.
OBJECTIVES: To determine the effectiveness and tolerability of opioid antagonists in the treatment of alcohol dependence.
SEARCH STRATEGY: We searched the Cochrane Drugs and Alcohol Group (CDAG) Specialized Register, PubMed, EMBASE and CINAHL in January 2010 and inquired manufacturers and researchers for unpublished trials.
SELECTION CRITERIA: All double-blind randomised controlled trials (RCTs) which compare the effects of naltrexone or nalmefene with placebo or active control on drinking-related outcomes.
DATA COLLECTION AND ANALYSIS: Two authors independently extracted outcome data. Trial quality was assessed by one author and cross-checked by a second author.
MAIN RESULTS: Based on a total of 50 RCTs with 7793 patients, naltrexone reduced the risk of heavy drinking to 83% of the risk in the placebo group RR 0.83 (95% CI 0.76 to 0.90) and decreased drinking days by about 4%, MD -3.89 (95% CI -5.75 to -2.04). Significant effects were also demonstrated for the secondary outcomes of the review including heavy drinking days, MD - 3.25 (95% CI -5.51 to -0.99), consumed amount of alcohol, MD - 10.83 (95% CI -19.69 to -1.97) and gamma-glutamyltransferase, MD - 10.37 (95% CI -18.99 to -1.75), while effects on return to any drinking, RR 0.96 (95 CI 0.92 to 1.00) missed statistical significance. Side effects of naltrexone were mainly gastrointestinal problems (e.g. nausea: RD 0.10; 95% CI 0.07 to 0.13) and sedative effects (e.g. daytime sleepiness: RD 0.09; 95% CI 0.05 to 0.14). Based on a limited study sample, effects of injectable naltrexone and nalmefene missed statistical significance. Effects of industry-sponsored studies, RR 0.90 (95% CI 0.78 to 1.05) did not significantly differ from those of non-profit funded trials, RR 0.84 (95% CI 0.77 to 0.91) and the linear regression test did not indicate publication bias (P = 0.765).
AUTHORS' CONCLUSIONS: Naltrexone appears to be an effective and safe strategy in alcoholism treatment. Even though the sizes of treatment effects might appear moderate in their magnitudes, these should be valued against the background of the relapsing nature of alcoholism and the limited therapeutic options currently available for its treatment.
Susanne Rösner; Andrea Hackl-Herrwerth; Stefan Leucht; Simona Vecchi; Manit Srisurapanont; Michael Soyka
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Publication Detail:
Type:  Journal Article; Meta-Analysis; Review     Date:  2010-12-08
Journal Detail:
Title:  The Cochrane database of systematic reviews     Volume:  -     ISSN:  1469-493X     ISO Abbreviation:  Cochrane Database Syst Rev     Publication Date:  2010  
Date Detail:
Created Date:  2010-12-14     Completed Date:  2011-02-10     Revised Date:  2013-06-28    
Medline Journal Info:
Nlm Unique ID:  100909747     Medline TA:  Cochrane Database Syst Rev     Country:  England    
Other Details:
Languages:  eng     Pagination:  CD001867     Citation Subset:  IM    
Psychiatric Hospital, University of Munich, Nußbaumstr. 7, Munich, Germany, 80336.
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MeSH Terms
Alcoholism / drug therapy*
Controlled Clinical Trials as Topic
Naltrexone / adverse effects,  analogs & derivatives*,  therapeutic use*
Narcotic Antagonists / adverse effects,  therapeutic use*
Randomized Controlled Trials as Topic
Reg. No./Substance:
0/Narcotic Antagonists; 16590-41-3/Naltrexone; TOV02TDP9I/nalmefene
Update Of:
Cochrane Database Syst Rev. 2005;(1):CD001867   [PMID:  15674887 ]

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