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 of 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 zero. The largest effect was found on abstinence (g = 0.468, p < .01), followed by heavy drinking (g = 0.406, p < .01), GGT (g = 0.324, p = .02), and craving (g = 0.312, p = .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).

Reduced Drinking in Alcohol Dependence Treatment, What Is the Evidence?

“…It is supposed to interact with alcohol's reinforcing effects on the brain [97]. A recent meta-analysis found topiramate to be more effective than placebo in promoting abstinence and reducing heavy drinking, with effect sizes that exceeded those of acamprosate, nalmefene, and naltrexone [98]. Of greatest relevance to this review, 3 studies tested topiramate against placebo with the explicit goal of reducing alcohol.…”

Anticonvulsants for the Treatment of Alcohol Withdrawal Syndrome and Alcohol Use Disorders

“…A recent meta-analysis of topiramate's effect on drinking showed significant effects for the medication versus placebo on measures of abstinence and heavy drinking, with estimated medium effect sizes ( g = 0.468, p = 0.02, and g = 0.406, p = 0.01, respectively) [115]. Topiramate has also proven efficacious when examining the FDA-preferred outcome “number of subjects with no heavy drinking days” [110, 116].…”

Nalmefene for reduced-risk drinking: it is not only fancy term for harm reduction

“…Also anticonvulsants were associated with fewer heavy drinking days (three studies, 308 participants, MD=-5.21, 95% Cl=-8.58 to -1.83) (33). A recent metaanalysis that included 7 RCTs (including a total of 1,125 participants) of topiramate treatment for AUDs found that although the largest effect was on abstinence (g=0.468, p<0.01), followed by the reduction of heavy drinking (g=0.406, p<0.01) (34).…”