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Meta-Analysis

Pharmacotherapies for Adults

With Alcohol Use Disorders: A
Systematic Review and Network
Meta-analysis
Anees Bahji et al. J Addict Med. 2022 Nov-Dec.
Free PMC article

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Abstract
Background: We aimed to determine
medications' comparative efficacy and safety
for adults with alcohol use disorders.

Methods: We searched eleven electronic data

sources for randomized clinical trials with at
least 4 weeks of treatment reporting on alcohol
consumption (total abstinence and reduced
heavy drinking), dropouts, and dropouts due to
adverse events. We conducted network meta-
analyses using random-effects, frequentist
models, and calculated summary rate ratios
(RRs) with 95% confidence intervals (CIs).

Results: We included 156 trials (N = 27,334).

Nefazodone (RR = 2.11; 95% CI, 1.42-3.13),
aripiprazole (RR = 1.97; 95% CI, 1.36-2.88),
carbamazepine (RR = 1.85; 95% CI, 1.03-3.32),
and nalmefene (RR = 1.17; 95% CI, 1.01-1.35)
were associated with the most dropouts.
Baclofen (RR = 0.83; 95% CI, 0.70-0.97) and
pregabalin (RR = 0.63; 95% CI, 0.43-0.94)
caused fewer dropouts than placebo.
Nalmefene (RR = 3.26; 95% CI, 2.34-4.55),
fluvoxamine (RR = 3.08; 95% CI, 1.59-5.94), and
topiramate (RR=2.18; 95% CI, 1.36-3.51) caused
more dropouts from adverse events over
placebo. Gamma-hydroxy-butyrate (RR = 1.90;
95% CI, 1.03-3.53), baclofen (RR = 1.80; 95%
CI, 1.39-2.34), disulfiram (RR = 1.71; 95% CI,
1.39-2.10), gabapentin (RR = 1.66; 95% CI,
1.04-2.67), acamprosate (RR = 1.33; 95% CI,
1.15-1.54), and oral naltrexone (RR = 1.15; 95%
CI, 1.01-1.32) improved total abstinence over
placebo (Fig. 3C). For reduced heavy drinking,
disulfiram (RR = 0.19; 95% CI, 0.10-0.35),
baclofen (RR = 0.72; 95% CI, 0.57-0.91),
acamprosate (RR = 0.78; 95% CI, 0.70-0.86),
and oral naltrexone (RR = 0.81; 95% CI, 0.73-
0.90) were efficacious against placebo.

Conclusions: The current meta-analyses

provide evidence that several medications for
AUDs are effective and safe and encourage the
expanded use of these medications in the
clinical setting. Our review found that
acamprosate (2-3 g/d), disulfiram (250-500
mg/d), baclofen (30 mg/d), and oral naltrexone
(50 mg/d) had the best evidence for improving
abstinence and heavy drinking for patients with
AUD.

Prospero: CRD42020208946.

Copyright © 2022 American Society of Addiction

Medicine.

PubMed Disclaimer

Conflict of interest statement

The authors report no conflicts of interest.

Figures

FIGURE 1. PRISMA flow diagram. PRISMA

indicates…

FIGURE 2. Network plot of eligible

pharmacotherapy…

FIGURE 3. Forest plot for networkmeta-analysis

across…

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Show all 43 references

Publication types
Meta-Analysis
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Systematic Review

MeSH terms
Acamprosate / adverse effects
Adult
Alcoholism* / drug therapy
Baclofen / adverse effects
Disulfiram / adverse effects
Humans
Naltrexone / adverse effects
Network Meta-Analysis
Randomized Controlled Trials as Topic

Substances
Acamprosate
Baclofen
Disulfiram
Naltrexone

Related information
PubChem Compound (MeSH Keyword)

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R25 DA037756/DA/NIDA NIH HHS/United States
R25 DA033211/DA/NIDA NIH HHS/United States

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