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Research Article | DOI: https://doi.org/10.31579/2767-7370/089
1School of Health Sciences, The University of Georgia, Kostava St. 77a, 0171 Tbilisi, Georgia.
2School of Science and Technology, The University of Georgia, Kostava St. 77a, 0171 Tbilisi, Georgia.
*Corresponding Author: Jalal Jbara, School of Health Sciences, The University of Georgia, Kostava St. 77a, 0171 Tbilisi, Georgia.
Citation: Jalal Jbara, Hedyeh Shaabani, Ekaterine Cherkezishvili, and Siavash H. Chermahini, (2024), Comparison of Acamprosate and Naltrexone Treatment in Patients with Alcohol Use Disorder (AUD) for Relapse Prevention. J New Medical Innovations and Research, 5(2); DOI:10.31579/2767-7370/089
Copyright: © 2024, Jalal Jbara. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 04 February 2024 | Accepted: 12 February 2024 | Published: 20 February 2024
Keywords: alcoholism; acamprosate; naltrexone; alcohol use disorder; relapse prevention
Alcohol use disorder (AUD) is a common disorder in the modern world. Interventions and treatments for AUD have not changed since 2010, using psychosocial interventions and medications such as acamprosate and naltrexone. The comparison between the effectiveness of acamprosate and naltrexone was conducted to provide the best option for relapse prevention and abstinence maintenance. The results were that some studies found that naltrexone was twice as effective as acamprosate in preventing relapses over a year. Others showed that acamprosate had better results in increasing the abstinence rate [OR: 1.88 (1.57, 2.25), P < 0.001] and naltrexone, on the other hand, had a significantly reduced relapse rate [OR: 0.62 (0, 52, 0.75), P < 0.001], but with no noticeable difference in abstinence rate [OR: 1.26 (0.97, 1.64), P = 0.08]. Furthermore, the combination of acamprosate and naltrexone was incomparably better at preventing relapse. In summary, naltrexone shows overall better results in preventing relapse and increasing abstinence rates.
Alcohol use disorder (AUD) refers to the abuse of alcohol.Several specifically definedconditions better categorize patterns of alcoholabuse. [1]. Alcoholism is another more common name for (AUD). Alcohol is a drug that is widely used in the world and accessible to many people, which opens the door to many more related problems. Since it is easy to obtain, it can be misused and mistreated, which can lead to many complications and health problems. According to a survey conducted in America, around 14.1 million adults aged 18 and over had AUD in 2019 [2]. AUDis caused by many factors; some are controllable, others are not. For example, genetic predisposition and family history of alcoholism are uncontrollable risk factors for alcoholism, which significantly increase the risk of alcoholism. On the other hand, controllable factors may include exposure to stress and trauma at a young age and consuming alcohol early in life [3]. Alcohol abuse has massive effects on health. It can affect most if not all major organs and cause diseases such as alcoholic hepatitis, gastritis, hypoglycemia, nystagmus, osteoporosis and many more. In addition, it can also affect areas of life other than health. It can ruin relationships, affect performance in the workplace, increase the likelihood of committing violent crimes and, even worse, lead to problems with the use of other riskier substances. There are some medications that are approved by the FDA to treat alcohol use disorders. These are (from first to last approval) disulfiram, acamprosate and naltrexone. Naltrexone was the last drug approved by the FDA in 1994. Since then, there have been some drugs that have been manufactured but not approved by the FDA and are used in some countries, such as: E.g. baclofen [3]. The FDA-approved drugs are used so far, but each drug has its own benefits and shows differences in responseto treatment [4]. According to BMJ Best Practice [1], the treatment algorithm for moderate to severe alcohol dependence primarily includes psychosocial interventions and additionally the use of medications such as naltrexone or acamprosate. This method of prescribing acamprosate and naltrexone has been used since 2010 and is still used today. Therefore, this research is importantbecause in the end it will be clear which drug is the most effective for treating alcohol use disorders, that is, drugs that can be used more effectively, do not waste resources, and prevent further complications of the already dangerous addiction from which they suffer.
During my research I used PUBMED using the MESH terms alcoholism AND acamprosate AND naltrexone. This returned 225 results. I then narrowed my search to clinical trials, randomized clinical trials, English, human species and full text and got 52 results, 4 of which I used. Finally, I narrowed my search to the systemic review, which gave me three results and used one of them.
The first source shows that the combination of acamprosate and naltrexone was much more effective in preventing relapses in alcohol-dependent patients. This meant that they reduced relapse rates [5]. The second source mentions that naltrexone was more effective in preventing relapses in alcohol dependent patients and that it was a better treatment for the period before the first relapse in order not to develop depression. Acamprosate also had only minor effects on patients [6]. The third source was a one-year long-termperiod to comparethe effects of naltrexone and acamprosate in their ability to keep alcohol-dependent patients away from alcohol and reduce their relapses. It has been shown that patients treated with naltrexone were twice as likely to abstain from alcohol than patients treated with acamprosate. Another statistic is that 41% of the naltrexone group did not relapse and 54
The different treatments such as naltrexone and acamprosate have shownvarying effectiveness in treating alcohol addiction. In the first study, the limitation was the limited duration of treatment, as 12 weeks was not enough to obtain the full results of the study [5]. The third source was that the study was not blinded. Another point is that the advantage of naltrexone may lie in the fact that the participants were patients with moderate alcoholdependence. In addition, the level of compliance with treatment was tested using questionnaires to the family, which may not have been very accurate, and another accurate method was to use riboflavin as a urine marker. Another possibility is that the use of GGT (a useful but not perfect indicatorof alcohol consumption) appeared to confirma better reportedoutcome in the naltrexone group, but the benefit did not reach statistical significance. Finally, in this study there was a high level of family support for the patients, if this had not been available the results could have differed [7]. The fourth limitation of the study was that the predictive validity of plasma levels for relapse could not be determined because blood was not collected after the event. Therefore, decrease in craving was chosen as the primary outcome measure. Although craving decreased with increasing plasma concentrations of naltrexone and 6-naltrexole, no upper threshold typically determined by adverse events was established because side effects were not known at the time [8]. The fifth study had some limitations. First, the comparison between study groups is not adequately justified and limits the results as the exact average daily/weekly pill count is unknown as the count was calculated using only the patient diary. With the exception of the DIS group, where average weekly alcohol consumption doubled but was still well below baseline, average weekly alcohol consumption remained at the level of the continuous medication period. The research drug was not under strict control or monitoring, which is the second limitation. The patients were asked to name a companion, which was not regulated by the research doctors. Therefore, the results are not comparable to studies that include a strict drug regimenor surveillance control [9].
In conclusion, naltrexone has shown better results than acamprosate in maintaining abstinence and preventing relapses, and in keeping alcohol-dependent patients away from alcohol and preventing relapses.
School of Health Sciences.
Conflict of interest: There is no conflictof interest.
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