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Alcoholism drugs work in study that may dispel physician doubts

Four medicines to treat alcoholism worked to reduce addiction, a study found, providing evidence that may overcome skepticism and spur greater use of the drugs.

Naltrexone; a generic medicine, acamprosate, sold under the brand name Campral by Forest Laboratories Inc.; Johnson & Johnson’s seizure medicine Topamax; and H. Lundbeck’s Selincro helped alcoholics reduce their drinking, an analysis of more than 120 studies found. The oldest U.S.-approved alcoholism drug – disulfiram, also known as Antabuse – didn’t prevent a return to drinking, according to Tuesday’s research in the Journal of the American Medical Association.

About 18 million Americans suffer from alcohol dependence or alcohol abuse, according to the National Institutes of Health. Yet only about a third of alcoholics receive any treatment for their condition and less than 10 percent get medications, said Daniel Jonas, the lead study author.

The drugs “are not used as much as they potentially could,” said Jonas, an associate professor of medicine at the University of North Carolina Chapel Hill, in a telephone interview. “Historically, that’s because of the uncertainty over whether they work. People with alcohol-use disorders have serious problems. They need help and they are often not getting help. One piece of the treatment is these medicines.”

Naltrexone interrupts the high of drinking, while acamprosate helps reduce the physical and emotional discomfort felt after a patient stops drinking. Doctors wrote 335,000 prescriptions for naltrexone last year and 132,000 for acamprosate, according to data compiled by Bloomberg.

Disulfiram, the drug the study found to be ineffective, generated the second-highest prescriptions at 178,000 last year. Disulfiram makes people sick when they drink, so it is difficult to test against a placebo or in randomized trials, the researchers said.

Selincro, known also as nalmefene, works by blocking brain signals that make activities such as sex and drinking feel good. The medicine isn’t sold in the United States. Topamax, which isn’t approved to treat alcoholism, may restore balance in the levels of chemicals released in the brain that are affected by alcoholism.

The research found that Vivitrol, an injectable form of naltrexone by Alkermes, reduced on average a patient’s heavy drinking days, but the evidence was insufficient because there weren’t enough studies.

In addition to lingering doubts about the drugs’ effectiveness, the medications aren’t used enough because most primary care doctors refer patients to specialists such as drug counselors, or community programs such as Alcoholics Anonymous, that aren’t able to prescribe these medicines, Jonas said.

About 3.3 million people died from harmful alcohol use in 2012, according to a report Monday from the World Health Organization. Consuming alcohol increases a person’s risk of developing more than 200 diseases including liver cirrhosis and cancer, the WHO estimates.

Katharine Bradley, who wrote an accompanying editorial, said the four effective treatments for people with alcohol use disorders should be used along with counseling and other support to aid recovery.

“We have effective medications for alcohol use disorders,” Bradley, a senior investigator at Group Health Research Institute in Seattle, said in a telephone interview. “Doctors should start prescribing these medications.”

Researchers in Tuesday’s study included more than 120 trials assessing the three drugs approved by the Food and Drug Administration for alcoholism as well as almost two dozen medicines cleared for other illnesses but used “off label” to treat alcoholics. In the studies, patients received counseling along with either the study drug or a placebo. The majority of the studies assessed naltrexone and acamprosate.

The researchers found that on average 12 people needed to be treated with acamprosate for one person to benefit, while 20 people needed to be treated with naltrexone for one person to benefit, Jonas said. No difference was seen between the two drugs when they were directly compared with each other for controlling alcohol consumption, the study showed.

As for Topamax and Selincro, people taking them had about one drink fewer on average on days they consumed alcohol, the study said. The researchers were unable to calculate the numbers needed to treat because the study measures for the drugs were different, Jonas said.

Future studies need to look at how long patients need to stay on these treatments for them to be effective, he said.

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