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A Meta‐Analysis of Topiramate's Effects for Individuals with Alcohol Use Disorders
Author(s) -
Blodgett Janet C.,
Del Re A. C.,
Maisel Natalya C.,
Finney John W.
Publication year - 2014
Publication title -
alcoholism: clinical and experimental research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.267
H-Index - 153
eISSN - 1530-0277
pISSN - 0145-6008
DOI - 10.1111/acer.12411
Subject(s) - topiramate , meta analysis , alcohol , psychology , medicine , clinical psychology , psychiatry , epilepsy , chemistry , biochemistry
Background Influenced by several trials and reviews highlighting positive outcomes, topiramate is increasingly prescribed as a treatment for alcohol use disorders ( AUD s). The only previously published meta‐analysis of topiramate for AUD s was limited by a sample of only 3 randomized, placebo‐controlled trials ( RCT s). Methods A systematic search identified 7 RCT s (including a total of 1,125 participants) that compared topiramate to placebo for the treatment for AUD s. This meta‐analysis estimated the overall effects of topiramate on abstinence, heavy drinking, craving, and γ ‐glutamyltranspeptidase ( GGT ) outcomes and included several sensitivity analyses to account for the small sample of studies. Results Overall, the small to moderate effects favored topiramate, although the effect on craving was not quite significantly different from 0. The largest effect was found on abstinence ( g = 0.468, p < 0.01), followed by heavy drinking ( g = 0.406, p < 0.01), GGT ( g = 0.324, p = 0.02), and craving ( g = 0.312, p = 0.07) outcomes. Sensitivity analyses did not change the magnitude or direction of the results, and tests did not indicate significant publication bias. The small sample size did not allow for examination of specific moderators of the effects of topiramate. Conclusions Topiramate can be a useful tool in the treatment of AUD s. Its efficacy, based on the current sample of studies, seems to be of somewhat greater magnitude than that of the most commonly prescribed medications for AUD s (naltrexone and acamprosate). Further research will help to identify the contexts in which topiramate is most beneficial (e.g., dose, concurrent psychotherapy, patient characteristics).