Sinclair 2014: how well people stuck to as-needed nalmefene

What they tested

The authors pooled medication-use data from two randomized, double-blind, placebo-controlled trials of nalmefene for alcohol dependence, 1,276 patients in all. The aim was to see whether taking a drug only as needed is a practical approach for people seeking help with their drinking.

Adherence was defined as either drinking and taking the medicine that day, or not drinking at all, with or without the medicine.

What they found

Nalmefene was taken on about half of study days (52.8%), and placebo was taken more often (64.5%).

In each group, how often people took the tablet seemed to follow their needs: intake was linked to their drinking pattern before the trial.

68% of nalmefene patients, and 78% of those who completed the study, followed the as-needed regimen on at least 80% of study days.

The authors concluded that as-needed use is a feasible, patient-centred approach that involves people in actively managing their drinking.

Limits

• It's a secondary analysis of medication-use data. It doesn't test whether as-needed dosing works better than daily dosing.
• Days without drinking counted as adherent even if no tablet was taken, which is a generous definition of sticking to the plan.
• It covers nalmefene, not naltrexone.

What it means if you're considering naltrexone

The Sinclair Method means taking naltrexone before drinking, only on drinking days. A common doubt about any as-needed plan is whether people will remember to take the pill when it counts. This analysis suggests most people in two nalmefene trials could follow that kind of schedule.

It used nalmefene, a close cousin of naltrexone, and it measured whether people followed the regimen, not how well the regimen worked.