Alcohol, Author Interviews, PLoS / 02.01.2016
No High-Grade Evidence Supporting Nalmefene For Alcohol Dependency
MedicalResearch.com Interview with:
Dr. Florian Naudet
INSERM Centre d'Investigation Clinique 1414
Faculté de Médecine, Centre Hospitalier
Universitaire de Rennes
Laboratoire de Pharmacologie Expérimentale et Clinique
Rennes, France
Medical Research: What is the background for this study? What are the main findings?
Dr. Naudet: To reduce harm, alcohol-dependent individuals are usually advised to abstain from drinking, but controlled (moderate) drinking may also be helpful. To help people reduce their alcohol consumption, the European Medicines Agency recently approved nalmefene for use in the treatment of alcohol dependence in adults who consume more than 60 g (for men) or 40 g (for women) of alcohol per day. However, several expert bodies have concluded that nalmefene shows no benefit over naltrexone, an older treatment for alcohol dependency, and do not recommend its use for this indication.
This is problematic because randomised controlled trials (RCTs) should lead to objective conclusions concerning treatment efficacy and this was not the case concerning nalmefene's approval.
We therefore performed a meta-analysis of aggregated data to enable an objective reappraisal of the efficacy of nalmefene for relevant health outcomes and on alcohol consumption endpoints at both 6 months (+/- 1 month) and 1 year (+/- 1 month).
We identified five RCTs that met the criteria for inclusion in our study. All five RCTs (which involved 2,567 participants) compared the effects of nalmefene with a placebo; none was undertaken in the population specified by the European Medicines Agency approval. Among the health outcomes examined in the meta-analysis, there were no differences between participants taking nalmefene and those taking placebo in mortality (death) after six months or one year of treatment, in the quality of life at six months. The RCTs included in the meta-analysis did not report other health outcomes. Participants taking nalmefene had fewer heavy drinking days per month at six months and one year of treatment than participants taking placebo, and their total alcohol consumption was lower. These differences were small in terms of clinical significance. Additionally, more people withdrew from the nalmefene groups than from the placebo groups, often for safety reasons. Thus, attrition bias cannot be excluded.
(more…)