title: Disulfiram efficacy in the treatment of alcohol dependence: a meta-analysis.
abstract: BACKGROUND
  Despite its success with compliant or supervised patients, disulfiram has been a controversial medication in the treatment of alcoholism. Often, study designs did not recognize a pivotal factor in disulfiram research, the importance of an open-label design. Our objectives are: (1) to analyze the efficacy and safety of disulfiram in RCTs in supporting abstinence and (2) to compare blind versus open-label studies, hypothesizing that blinded studies would show no difference between disulfiram and control groups because the threat would be evenly spread across all groups.
  
  
  RESULTS
  We searched PubMed, EMBASE and the Cochrane Central Register for RCTs on disulfiram use with alcoholics in comparison to any alcoholic control group. The primary outcome was defined by the authors of each trial. Additional analyses included: blind vs. open-label, with or without supervision, cocaine study or not, and type of control. Overall, the 22 included studies showed a higher success rate of disulfiram compared to controls Hedges'g = .58 (95%CI = .35-.82). When comparing blind and open-label RCTs, only open-label trials showed a significant superiority over controls g = .70 (95%CI = .46-.93). RCTs with blind designs showed no efficacy of disulfiram compared to controls. Disulfiram was also more effective than the control condition when compared to naltrexone g = .77, 95%CI = .52-1.02, to acamprosate g = .76, 95%CI = .04-1.48, and to the no disulfiram groups g = .43, 95%CI = .17-.69. LIMITS INCLUDE: (1) a population of 89% male subjects and (2) a high but unavoidable heterogeneity of the studies with a substantial I-square in most subgroups of studies.
  
  
  CONCLUSIONS
  Blinded studies were incapable of distinguishing a difference between treatment groups and thus are incompatible with disulfiram research. Based on results with open-label studies, disulfiram is a safe and efficacious treatment compared to other abstinence supportive pharmacological treatments or to no disulfiram in supervised studies for problems of alcohol abuse or dependence.
authors: Centre de Traitement des Addictions, Hôpital Emile Roux, Assistance Publique-Hôpitaux de Paris, Institut National de la Santé et de la Recherche Médicale U669, Limeil-Brévannes, France.
authors: Marilyn D
authors: MD
authors: Skinner
authors: Centre de Traitement des Addictions, Hôpital Emile Roux, Assistance Publique-Hôpitaux de Paris, Limeil-Brévannes, France.
authors: Pierre
authors: P
authors: Lahmek
authors: Centre Médical Marmottan Paris, France.
authors: Héloïse
authors: H
authors: Pham
authors: Centre d'Enseignement, de Recherche et de Traitement des Addictions, Hôpital Paul Brousse, Assistance Publique-Hôpitaux de Paris, Université Paris-Sud, Institut National de la Santé et de la Recherche Médicale U669, Villejuif, France.
authors: Henri-Jean
authors: HJ
authors: Aubin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000427:Alcohol Deterrents / Q000009:adverse effects / Q000627:therapeutic use*; D000437:Alcoholism / Q000188:drug therapy*; D016022:Case-Control Studies; D003042:Cocaine / Q000009:adverse effects; D004221:Disulfiram / Q000009:adverse effects / Q000627:therapeutic use*; D023381:Endpoint Determination; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
chemical_list: D000427:Alcohol Deterrents; D003042:Cocaine; D004221:Disulfiram