Efficacy of Extended-Release Naltrexone on HIV-Related and Drinking Outcomes Among HIV-Positive Patients: A Randomized-Controlled Trial

Edelman, E. Jennifer; Moore, Brent A.; Holt, S; Hansen, Nathan B.; Kyriakides, Tassos C.; Virata, Michael; Brown, Sheldon T.; Justice, Amy C.; Bryant, Kendall; Fiellin, David A.; Fiellin, Lynn E.

doi:10.1007/s10461-018-2241-z

Cited by 25 publications

(33 citation statements)

References 61 publications

(83 reference statements)

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“…As shown in Table 1, two of these studies have used oral naltrexone (NTX) [44,49] and the 5 other used extendedrelease injectable form (XR-NTX) [45][46][47][48]50]. The difference between reported outcomes and a small number of studies has made it difficult to present results in a metaanalysis.…”

Section: Resultsmentioning

confidence: 99%

“…Of the 51 participants who enrolled in the study by Edelman et al, 2019, only 23 participants remained in the study for up to 24 weeks [45]. 82% of Cook et al, 2017 study participants completed the course of treatment [44].…”

Section: Evaluated Outcomes Treatment Retentionmentioning

confidence: 99%

“…They received naltrexone (daily 50 mg orally) or placebo randomly to reduce drinking [44]. Participants were divided [45]. Edelman et al, 2019 observed that compared to the placebo group, the XR-NTX assigned group had fewer past 30-day heavy and abstinent drinking days (p = 0.03).…”

Section: Drinking Outcomesmentioning

confidence: 99%

“…Edelman et al, 2019 observed that compared to the placebo group, the XR-NTX assigned group had fewer past 30-day heavy and abstinent drinking days (p = 0.03). Moreover, for the XR-NTX group phosphatidylethanol (PEth, an alcohol biomarker) values decreased over time (p = 0.03) [45]. assessed the effects of XR-NTX for treating AUDs in PLH.…”

Section: Drinking Outcomesmentioning

confidence: 99%

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Effectiveness of naltrexone treatment for alcohol use disorders in HIV: a systematic review

Farhadian

Moradi

Zamanian

et al. 2020

Subst Abuse Treat Prev Policy

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Background: Because alcohol use disorders (AUDs) in patients living with HIV/AIDS are associated with a reduction in therapeutic outcomes and increases the risk of morbidity/mortality, finding an appropriate pharmacotherapy treatment for this disorder is necessary. Objectives: This systematic review contains studies that examine the effects of pharmacological intervention (oral naltrexone (NTX) or injectable extended-release naltrexone (XR-NTX)) on the persons living with HIV and AUDs. Methods: A systematic literature search using three electronic databases including Pubmed Medline, Scopus and the Cochrane Library and Google Scholar was conducted and includes articles published from 1995 to 2019. Records were collected by searching relevant keywords and those that meet the inclusion/exclusion criteria are included. Results: Overall, in this systematic review, the results of 7 relevant studies including pilot and randomized controlled/ clinical trials were summarized and reviewed. Among selected records 2 of these assessed the efficacy of NTX and 5 tested the XR-NTX effectiveness in treating AUDs among persons living with HIV (PLH). In summary, with some expectations, NTX and XR-NTX administration in persons living with HIV and AUDs led to reduced alcohol use, improved viral suppression, unchanged ART adherence and has no significant adverse events. Conclusion: The findings of this systematic review suggest the beneficial effects and safety of the NTX and XR-NTX for treating AUDs in PLH. Further studies are needed in the future to focus on the treatment of AUDs in people living with HIV.

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Section: Resultsmentioning

confidence: 99%

Section: Evaluated Outcomes Treatment Retentionmentioning

confidence: 99%

Section: Drinking Outcomesmentioning

confidence: 99%

Section: Drinking Outcomesmentioning

confidence: 99%

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Effectiveness of naltrexone treatment for alcohol use disorders in HIV: a systematic review

Farhadian

Moradi

Zamanian

et al. 2020

Subst Abuse Treat Prev Policy

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“…Most clinical trials involving naltrexone have only examined its effect on drinking, although reanalysis of at least one study one study demonstrated that reduction in drinking among clinical trial participants is accompanied by improvements in clinical health such as blood pressure, liver enzymes, and quality of life (Witkiewitz et al., ). Two recent studies sought to determine whether naltrexone or other alcohol‐related therapy can improve HIV outcomes, one of which found that reductions in drinking were associated with improved HIV viral suppression (Edelman et al., ; Springer et al., ).…”

Section: Discussionmentioning

confidence: 99%

Reduction in Drinking was Associated With Improved Clinical Outcomes in Women With HIV Infection and Unhealthy Alcohol Use: Results From a Randomized Clinical Trial of Oral Naltrexone Versus Placebo

Cook

Zhou

Míguez

et al. 2019

Alcoholism Clin & Exp Res

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Background: Alcohol consumption is associated with poor health outcomes in women living with HIV (WLWH), but whether medication can help to reduce drinking in non-treatment-seeking women or whether reduction in drinking improves HIV outcomes is unclear. We conducted a randomized clinical trial (RCT) of daily oral naltrexone (50 mg) versus placebo in WLWH who met criteria for current unhealthy alcohol use.Methods: WLWH with current unhealthy alcohol use (>7 drinks/wk or >3 drinks/occasion) were randomly assigned to daily oral naltrexone 50 mg (n = 96) or placebo (n = 98) for 4 months. Drinking outcomes, including the proportion of women who reduced (

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Pharmacotherapy for Alcohol Use Disorder

McPheeters,

O’Connor,

Riley

et al. 2023

JAMA

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ImportanceAlcohol use disorder affects more than 28.3 million people in the United States and is associated with increased rates of morbidity and mortality.ObjectiveTo compare efficacy and comparative efficacy of therapies for alcohol use disorder.Data SourcesPubMed, the Cochrane Library, the Cochrane Central Trials Registry, PsycINFO, CINAHL, and EMBASE were searched from November 2012 to September 9, 2022 Literature was subsequently systematically monitored to identify relevant articles up to August 14, 2023, and the PubMed search was updated on August 14, 2023.Study SelectionFor efficacy outcomes, randomized clinical trials of at least 12 weeks’ duration were included. For adverse effects, randomized clinical trials and prospective cohort studies that compared drug therapies and reported health outcomes or harms were included.Data Extraction and SynthesisTwo reviewers evaluated each study, assessed risk of bias, and graded strength of evidence. Meta-analyses used random-effects models. Numbers needed to treat were calculated for medications with at least moderate strength of evidence for benefit.Main Outcomes and MeasuresThe primary outcome was alcohol consumption. Secondary outcomes were motor vehicle crashes, injuries, quality of life, function, mortality, and harms.ResultsData from 118 clinical trials and 20 976 participants were included. The numbers needed to treat to prevent 1 person from returning to any drinking were 11 (95% CI, 1-32) for acamprosate and 18 (95% CI, 4-32) for oral naltrexone at a dose of 50 mg/d. Compared with placebo, oral naltrexone (50 mg/d) was associated with lower rates of return to heavy drinking, with a number needed to treat of 11 (95% CI, 5-41). Injectable naltrexone was associated with fewer drinking days over the 30-day treatment period (weighted mean difference, −4.99 days; 95% CI, −9.49 to −0.49 days) Adverse effects included higher gastrointestinal distress for acamprosate (diarrhea: risk ratio, 1.58; 95% CI, 1.27-1.97) and naltrexone (nausea: risk ratio, 1.73; 95% CI, 1.51-1.98; vomiting: risk ratio, 1.53; 95% CI, 1.23-1.91) compared with placebo.Conclusions and RelevanceIn conjunction with psychosocial interventions, these findings support the use of oral naltrexone at 50 mg/d and acamprosate as first-line pharmacotherapies for alcohol use disorder.

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Efficacy of Extended-Release Naltrexone on HIV-Related and Drinking Outcomes Among HIV-Positive Patients: A Randomized-Controlled Trial

Cited by 25 publications

References 61 publications

Effectiveness of naltrexone treatment for alcohol use disorders in HIV: a systematic review

Effectiveness of naltrexone treatment for alcohol use disorders in HIV: a systematic review

Reduction in Drinking was Associated With Improved Clinical Outcomes in Women With HIV Infection and Unhealthy Alcohol Use: Results From a Randomized Clinical Trial of Oral Naltrexone Versus Placebo

Pharmacotherapy for Alcohol Use Disorder

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