Acamprosate, Naltrexone Have Best Evidence for Alcohol Use Disorder

Background: An estimated 30 million Americans reported alcohol use disorder in 2021, but only an estimated 265,000 (0.9%) received pharmacotherapy for alcohol use disorder. Objective: To evaluate the evidence for efficacy among therapies used for alcohol use disorder. Design: Systematic review and meta-analysis. Methods: Data from 118 randomized clinical trials and 20,976 participants were included. Only trials of at least 12 weeks’ duration were included. Meta-analyses used random effects models. Two reviewers evaluated each study, assessed risk of bias, and graded strength of evidence. Results: There was moderate evidence of efficacy for use of acamprosate and naltrexone in alcohol use disorder. The number needed to treat (NNT) to prevent 1 person from returning to any drinking was 11 for acamprosate (95% CI, 1 to 32) and 18 for oral naltrexone 50 mg daily (95% CI, 4 to 32). There was also moderate evidence supporting oral naltrexone use for reducing rates of return to heavy more...