title: A meta-analysis of topiramate's effects for individuals with alcohol use disorders.
abstract: BACKGROUND
  Influenced by several trials and reviews highlighting positive outcomes, topiramate is increasingly prescribed as a treatment for alcohol use disorders (AUDs). The only previously published meta-analysis of topiramate for AUDs was limited by a sample of only 3 randomized, placebo-controlled trials (RCTs).
  
  
  METHODS
  A systematic search identified 7 RCTs (including a total of 1,125 participants) that compared topiramate to placebo for the treatment for AUDs. This meta-analysis estimated the overall effects of topiramate on abstinence, heavy drinking, craving, and γ-glutamyltranspeptidase (GGT) outcomes and included several sensitivity analyses to account for the small sample of studies.
  
  
  RESULTS
  Overall, the small to moderate effects favored topiramate, although the effect on craving was not quite significantly different from 0. The largest effect was found on abstinence (g = 0.468, p < 0.01), followed by heavy drinking (g = 0.406, p < 0.01), GGT (g = 0.324, p = 0.02), and craving (g = 0.312, p = 0.07) outcomes. Sensitivity analyses did not change the magnitude or direction of the results, and tests did not indicate significant publication bias. The small sample size did not allow for examination of specific moderators of the effects of topiramate.
  
  
  CONCLUSIONS
  Topiramate can be a useful tool in the treatment of AUDs. Its efficacy, based on the current sample of studies, seems to be of somewhat greater magnitude than that of the most commonly prescribed medications for AUDs (naltrexone and acamprosate). Further research will help to identify the contexts in which topiramate is most beneficial (e.g., dose, concurrent psychotherapy, patient characteristics).
authors.affiliation: HSR&D Center for Innovation to Implementation , VA Palo Alto Health Care System, Menlo Park, California.
authors.forename: Janet C
authors.initials: JC
authors.lastname: Blodgett
authors.forename: A C
authors.initials: AC
authors.lastname: Del Re
authors.forename: Natalya C
authors.initials: NC
authors.lastname: Maisel
authors.forename: John W
authors.initials: JW
authors.lastname: Finney
mesh_terms: D000428:Alcohol Drinking / Q000188:drug therapy / Q000453:epidemiology; D000437:Alcoholism / Q000188:drug therapy*; D018691:Excitatory Amino Acid Antagonists / Q000627:therapeutic use*; D005632:Fructose / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006801:Humans; D000077236:Topiramate; D016896:Treatment Outcome
chemical_list: D018691:Excitatory Amino Acid Antagonists; D000077236:Topiramate; D005632:Fructose
keywords: Alcohol Use Disorders; Meta-Analysis; Topiramate; Treatment