Comparative Effectiveness of Pharmacological Treatments in Alcohol Use Disorder (AUD) - A Systematic Literature Review (SLR) and Network-Meta Analysis (NMA)

Speaker(s)

Ahn H1, Vanness D2, Segel JE3, Kawasaki SS4
1Penn State University, University Park, PA, USA, 2Pennsylvania State University, University Park, PA, USA, 3The Pennsylvania State University, University Park, PA, USA, 4Pennsylvania State University College of Medicine, Hershey, PA, USA

Presentation Documents

OBJECTIVES:

To evaluate the efficacy of the pharmacological treatments, naltrexone, extended-release naltrexone (XR-NTX), acamprosate, disulfiram, baclofen, topiramate, and gabapentin, in adults with AUD.

METHODS:

In February 2022, we performed a SLR in PubMed, Cochrane Library, Web of Science, and ClinicalTrial.gov to identify randomized controlled trials of AUD pharmacological treatments. Drinking outcome measures were number of drinks per day (DPD), drinks per drinking day (DPDD), percent drinking days (%DD), and percent heavy drinking days (%HDD). Bayesian fixed and random effects NMA with normal family and identity link models were used, and placebo was the common comparator.

RESULTS:

After screening 2,831 records, 61 RCTs involving 8,666 participants were included in the primary evidence network. Six studies provided direct comparisons between drugs. For DPD, the treatments with the highest probability of being ranked first were disulfiram (34.6%) and topiramate (19.7%). Topiramate had the highest probability of ranking first for DPDD (52.8%), %DD (35.0%), and %HDD (88.8%), respectively. Across all drinking outcomes, topiramate had statistically significantly better outcomes compared to placebo; DPD (MD = -1.75 [95% CrI: -3.28, -0.39]), DPDD (-1.85 [-3.14,-0.60]), %DD (-0.13 [-0.23, -0.05]), and %HDD (-0.17 [-0.23,-0.11]). Naltrexone was better than placebo in all drinking outcomes, but no statistically significant differences were found. Acamprosate showed efficacy against placebo for DPD and DPDD but not for %DD and %HDD; gabapentin showed efficacy against placebo for %DD and %HDD but it did not for DPD and DPDD.

CONCLUSIONS:

Topiramate consistently showed efficacy relative to placebo across a variety of drinking outcomes. Evidence on the efficacy of other treatments was mixed, with inference limited by substantial uncertainty. Future work will explore whether multivariate meta-analysis may further reduce uncertainty by “borrowing” information across related outcomes.

Code

CO106

Topic

Clinical Outcomes, Study Approaches

Topic Subcategory

Comparative Effectiveness or Efficacy, Literature Review & Synthesis, Meta-Analysis & Indirect Comparisons

Disease

Drugs, Mental Health (including addition)