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DOI: 10.1055/a-1494-4333
Systematische Literaturübersicht der Wirksamkeit von Acamprosat, Naltrexon, Disulfiram und Nalmefen zur Trinkmengenreduktion und Aufrechterhaltung der Abstinenz bei Alkoholabhängigkeit
A Systematic Review of the Effectiveness of Acamprosate, Naltrexone, Disulfiram and Nalmefene for Reducing Alcohol Consumption and Maintaining Abstinence with Alcohol Dependence
Zusammenfassung
Das Ziel der vorliegenden Übersichtsarbeit ist die systematische Darstellung der aktuellen Evidenz zur Wirksamkeit von Acamprosat, Naltrexon, Disulfiram und Nalmefen für die Aufrechterhaltung der Abstinenz oder Trinkmengenreduktion bei alkoholabhängigen Patient:innen. Bezogen auf den Zeitraum 2005 bis 2020 wurden insgesamt 27 Studien identifiziert, die alle Einschlusskriterien (u. a. RCT, mind. 8 Wochen Behandlungsdauer) erfüllten. Es wurden überwiegend Hinweise zur Wirksamkeit von Nalmefen gefunden. Acamprosat war nicht (zusätzlich) wirksam. Naltrexon trug in kombinierten Interventionen einen zusätzlichen Nutzen bei, dies galt jedoch nicht für die Mehrzahl der Studien. Disulfiram war nicht wirksam darin, einen zusätzlichen Nutzen zur Erhaltung der Abstinenz beizutragen, im Vergleich zu Topiramat, einem Antikonvulsivum, jedoch effektiver. Die Ergebnisse stehen nicht im Einklang mit dem bisher bekannten Forschungsstand, der Acamprosat, Naltrexon und Nalmefen als überwiegend effektiv und sicher einstuft und Disulfiram als mäßig wirksam. Der pharmakologische Interventionsbedarf sollte bei Bestehen alkoholbezogener Probleme exploriert und ggf. erwogen werden, damit diesbezüglich Vorbehalte abgebaut und ein umfassendes und zugleich individuelles Behandlungsangebot geschaffen wird. Hinsichtlich der Trinkmengenreduktion sollten Aspekte der Schadensminderung als Behandlungsziel berücksichtigt werden.
Abstract
The aim of this review is the systematic presentation of relevant literature on the effectiveness of acamprosate, naltrexone, disulfiram and nalmefene for maintaining abstinence or reducing alcohol consumption in alcohol dependent patients. A systematic literature search identified a total of 27 studies which met all inclusion criteria (i.a. RCTs, at least 8 weeks treatment). Mostly indications for the effectiveness of nalmefene were found. Acamprosate was not (additionally) effective. Naltrexon showed an added benefit in combined interventions, but not for the majority of studies. Disulfiram was not effective in providing an additional benefit but was more effective compared to topiramate (anticonvulsive agent). These results differ from the prevailing research, which classifies acamprosate, naltrexone and nalmefene as predominantly effective and safe and disulfiram as moderately effective. Looking into the future, the need for medical interventions in the presence of alcohol-related problems should be considered, so that barriers can be removed and a wide range of treatment is created. Especially harm reduction should be taken into account as a treatment goal in reducing drinking.
Schlüsselwörter
Alkoholabhängigkeit - pharmakologische Behandlung - Acamprosat - Naltrexon - Disulfiram - NalmefenKey words
alcohol dependence - pharmacological treatment - acamprosate - naltrexone - disulfiram - nalmefenePublication History
Article published online:
13 August 2021
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