Laaksonen 2008: disulfiram vs naltrexone vs acamprosate

What they tested

Patients were randomly assigned to naltrexone 50 mg, acamprosate 1998 mg or disulfiram 200 mg a day, each with a brief, manual-based cognitive behavioural program. Disulfiram causes an unpleasant reaction when people drink.

For the first 12 weeks, medicine was taken under supervision. After that, patients used it in a targeted way, when they felt they needed it, for up to 52 weeks, followed by a further 67 weeks of follow-up. The trial was open-label, so patients and staff knew who was taking what.

What they found

All three groups drank much less by the end of the study than at the start, and reported better quality of life.

During the 12-week supervised phase, disulfiram beat both other drugs on heavy drinking days, average weekly intake, time to first drink and number of abstinent days.

During the targeted phase, the groups didn't differ on time to first heavy drinking day or first drinking day, but disulfiram patients had significantly more abstinent days than those on acamprosate or naltrexone.

Naltrexone and acamprosate did not differ on drinking outcomes in either phase. Scores on a measure of alcohol dependence severity (SADD) improved more with naltrexone than with acamprosate.

Limits

• It was open-label, so knowing which drug they had may have affected how patients behaved and reported their drinking.
• There was no placebo group, so it shows how the drugs compared with each other, not how each compared with no medicine.
• Disulfiram was given under supervision in the first phase, which may not match how people take it on their own.

What it means if you're considering naltrexone

For someone weighing naltrexone against disulfiram, this trial is one where supervised disulfiram came out ahead, mostly in the first 12 weeks. It also found naltrexone and acamprosate performed about the same on drinking.

Its targeted phase is one of the few long tests of taking naltrexone as needed, and in that phase naltrexone didn't outperform acamprosate on drinking.