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

• Published in: Addiction (Abingdon, England) Vol. 119; no. 5; pp. 815 - 832
• Main Authors: Kotake, Kazumasa, Hosokawa, Tomonari, Tanaka, Masuo, So, Ryuhei, Banno, Masahiro, Kataoka, Yuki, Shiroshita, Akihiro, Hashimoto, Yasuhiko
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01.05.2024
• Subjects: Adverse events; alcohol dependence; alcohol reduction pharmacotherapy; Alcohol related disorders; Alcohol use; alcohol use disorder; Alcoholism; Baclofen; Clinical research; Clinical trials; Critical incidents; Drinking behavior; Drug dependence; Drug therapy; Efficacy; Meta-analysis; Nalmefene; network meta‐analysis; Patients; Pharmacology; Placebos; Relapse; Safety; Systematic review; Topiramate; treatment duration; treatment duration; alcohol use disorder; network meta‐analysis; alcohol reduction pharmacotherapy; systematic review; alcohol dependence
• ISSN: 0965-2140; 1360-0443; 1360-0443
• DOI: 10.1111/add.16421

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.