Lack of efficacy of naltrexone in the prevention of alcohol relapse: results from a German multicenter study.
In a placebo-controlled, double-blind German multicenter study (seven sites) the efficacy of naltrexone as an adjunctive treatment in alcoholism to maintain abstinence was assessed for 12 weeks. A total of 171 detoxified patients (97.7% met the DSM-III-R criteria for alcohol dependence) were included. Patients had been abstinent for a mean of 19.5 +/- 9.4 days at study entry. Eighty-four and 87 patients were randomized to receive naltrexone (50 mg/day) and placebo, respectively. Each site was instructed to provide its usual psychosocial alcohol treatment program. The primary effectiveness measure was the time to first heavy drinking as derived from self-reports of drinking (timeline-follow-back method). Secondary effectiveness measures included time to first drink, amount of alcohol consumption, intensity of craving, severity of alcoholism problems, and liver enzymes. Thirty-three (38%) placebo patients and 28 (33%) naltrexone patients discontinued the study. At endpoint, 62% of the patients in each group did not have an episode of heavy drinking. Also, there were no significant differences between the study groups concerning secondary effectiveness measures as well as compliance and adverse clinical events--with the exception of the gamma-GT, which was significantly greater reduced in the naltrexone group throughout the study. Based upon an intention-to-treat population, this study confirms the safety but not the efficacy of naltrexone in prevention of alcohol relapse. Nevertheless, the question arises whether self-reports of drinking are more reliable than gamma-GT as a measure of recent alcohol consumption.
Gastpar
Markus
M
Department of Psychiatry of the University of Essen, Germany. markus.gastpar@uni-essen.de
Bonnet
Udo
U
Böning
Jobst
J
Mann
Karl
K
Schmidt
Lutz G
LG
Soyka
Michael
M
Wetterling
Tilman
T
Kielstein
Volker
V
Labriola
Dominic
D
Croop
Robert
R
D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D000437:Alcoholism / Q000188:drug therapy / Q000517:prevention & control* / Q000534:rehabilitation; D001219:Aspartate Aminotransferases / Q000097:blood; D004311:Double-Blind Method; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D009271:Naltrexone / Q000627:therapeutic use*; D009292:Narcotic Antagonists / Q000627:therapeutic use*; D012008:Recurrence; D011795:Surveys and Questionnaires; D013695:Temperance; D016896:Treatment Outcome; D005723:gamma-Glutamyltransferase / Q000097:blood
D009292:Narcotic Antagonists; D009271:Naltrexone; D005723:gamma-Glutamyltransferase; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase