Naltrexone in the treatment of male alcoholics - an effectiveness study in Singapore

Abstract

Naltrexone has been demonstrated in western studies to be a useful pharmacological adjunct within treatment programmes for alcoholic patients. We report the first study of its efficacy and usefulness in an Asian region. This project was designed to allow naltrexone˜s performance to be assessed under routine clinical conditions but with patients selected on the basis of their being likely to comply. Following in-patient detoxification, 53 male alcohol-dependent patients admitted to the Alcohol Treatment Centre at Woodbridge Hospital, Singapore, were enrolled in a 12-week, placebocontrolled trial of naltrexone hydrochloride (50 mg/day). Subjects were randomized on a 2:1 basis, with 35 receiving naltrexone and 18 receiving placebo. Analyses identified that a higher percentage of naltrexone patients completed the study (40% vs. 22%). In the study non-completers, the dropout rate due to drinking relapse was also lower in the naltrexone group (9% vs. 43%). Of the 39 patients for whom drinking status over the trial could be ascertained, fewer naltrexone-treated patients drank (33% vs. 53%). Alcohol craving scores also showed a selective and distinct reduction in the naltrexone-treated group. Results suggest that naltrexone may be an effective and safe aid to treatment of alcohol dependent patients in Asian patients, for whom the aims are to reduce alcohol craving and drinking reinstatement, but where compliance is likely to be low. [Lee A, Tan S, Lim D, Winslow RM, Wong KE, Allen J, Hall W, Parker G. Naltrexone in the treatment of male alcoholics-an effectiveness study in Singapore. Drug Alcohol Rev 2001;20:193 199]

The efficacy of acamprosate and naltrexone in the treatment of alcohol dependence, Europe versus the rest of the world: a meta‐analysis

“…Twenty‐seven studies were identified by the NICE guideline as meeting inclusion criteria . An additional two studies were identified for inclusion in the current review , but one did not report the relevant outcomes and so was excluded for the purposes of this review.…”

“…It was decided that this methodology was not in accordance with the aims of this review. Therefore, a total of 27 studies were included in the current review that investigated the efficacy of naltrexone for alcohol relapse prevention . A total of 2253 participants in the naltrexone group and 1946 participants in the placebo group were included in the meta‐analysis.…”

“…A total of 2253 participants in the naltrexone group and 1946 participants in the placebo group were included in the meta‐analysis. In contrast to the acamprosate studies, the majority of the naltrexone studies included in this review were conducted outside Europe, predominantly in the United States , with only seven studies conducted within Europe . The characteristics of the studies of naltrexone included in the meta‐analysis are presented in the Supporting information, Table S3).…”

Naltrexone for the treatment of alcoholism: a meta-analysis of randomized controlled trials

“…We excluded four studies not using the double-blindness design (Lee et al, 2001 ;Rubio et al, 2001Rubio et al, , 2002 and a clearly defined diagnostic system (Huang et al, 2002). Twenty-four papers were identified as original articles presenting main findings of 24 RCTs (see Table 1).…”

Long-term effects of pharmacotherapy on relapse prevention in alcohol dependence

“…As alcohol intake enhances endogenous opioid activity in the central nervous system, it has been proposed that opioid antagonists like naltrexone reduce the risk of relapse. Up to now, the results of 11 controlled studies with a total of about 1500 patients have been published (23–33). With the exception of the results of two multicenter trials (32,33), the other results revealed a superiority of naltrexone to placebo.…”