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Clinical and biological moderators of response to naltrexone in alcohol dependence: a systematic review of the evidence
Author(s) -
Garbutt James C.,
Greenblatt Amy M.,
West Suzanne L.,
Morgan Laura C.,
KampovPolevoy Alexei,
Jordan Harmon S.,
Bobashev Georgiy V.
Publication year - 2014
Publication title -
addiction
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.424
H-Index - 193
eISSN - 1360-0443
pISSN - 0965-2140
DOI - 10.1111/add.12557
Subject(s) - naltrexone , alcohol dependence , randomized controlled trial , placebo , meta analysis , craving , medicine , moderation , alcohol use disorder , clinical psychology , psychology , psychiatry , alcohol , addiction , opioid , alternative medicine , social psychology , biochemistry , chemistry , receptor , pathology
Aim The goal of this systematic review was to identify moderators of naltrexone efficacy in the treatment of alcohol dependence. Methods We searched P ubmed, CINHAL , E mbase, P sycINFO and the C ochrane L ibrary from 1990 to A pril 2012 and reference lists of pertinent review articles, which yielded 622 trial, pooled analysis and review articles. Using pre‐established eligibility criteria, two reviewers independently determined whether abstracts contained evidence of demographic or biological characteristics, i.e. moderators, influencing naltrexone response in alcohol dependence. We assessed each publication for risk of bias and evaluated the strength of the body of evidence for each moderator. Results Twenty‐eight publications (on 20 studies) met criteria for data synthesis. These included 26 publications from 12 randomized, placebo‐controlled trials, three non‐randomized, non‐placebo studies and one randomized, non‐placebo study. In addition, there were two publications from pooled analyses of four randomized, placebo‐controlled trials. Family history of alcohol problems and the A sn40 A sp polymorphism of the μ‐opioid receptor gene showed a positive association with efficacy in four of five and three of five studies, respectively. Other moderators reported to be associated with efficacy included male sex (two of five studies), pre‐treatment drinking (two of two studies) and high craving (two of five studies). However, the overall risk of bias in the published literature is high. Conclusions The identification of naltrexone‐responsive alcohol‐dependent patients is still in development. Studies to date point to two potential moderators—family history and presence of the OPRM 1 A sn40 A sp polymorphism—as having the strongest evidence. However, the data to date is still insufficient to recommend that any moderator be used in determining clinical treatment.