Relapse Prevention by Acamprosate

TLDR

Acamprosate (calcium bisacetylhomotaurinate) was evaluated for its ability to maintain abstinence in alcohol‑dependent patients over a one‑year period. A randomized, double‑blind, placebo‑controlled trial enrolled 272 detoxified patients who received routine counseling and either acamprosate or placebo for 48 weeks, followed by 48 weeks of observation without medication, with intention‑to‑treat analysis. Acamprosate produced higher continuous abstinence rates (67% vs 50% in the first 60 days, 43% vs 21% overall) and longer mean abstinence duration (224 vs 163 days, 62% vs 45% days abstinent), with no difference in psychiatric symptoms, a lower dropout rate (41% vs 60%), few side effects, and 39% of patients remained abstinent after an additional 48 weeks off medication.

Abstract

<h3>Background</h3> The effectiveness acamprosate (calcium bisacetylhomotaurinate) as a treatment to maintain abstinence in alcohol-dependent patients was assessed for 1 year. <h3>Methods:</h3> After short-term detoxification, 272 patients participated in a randomized, double-blind, placebo-controlled study. Patients received routine counseling and either the study medication or placebo for 48 weeks; they were followed up for another 48 weeks without medication. Statistical analysis was performed according to the intention-to-treat principle. <h3>Results:</h3> Patients who were receiving acamprosate showed a significantly higher continuous abstinence rate within the first 60 days of treatment compared with patients who were assigned to placebo treatment (67% vs 50%) until completion of the treatment period (43% vs 21%, log rank<i>P</i>=.005), and they had a significantly longer mean abstinence duration of 224 vs 163 days, or 62% vs 45% days abstinent (<i>P</i>&lt;.001); however, there was no difference in psychiatric symptoms. Of the patients who were receiving acamprosate, 41% had dropped out, whereas 60% of the placebo-treated patients dropped out of the study. Few side effects (mainly diarrhea and headache) were recorded. At the end of a further 48 weeks without receiving study medication, 39% and 17% of the acamprosate- and placebo-treated patients, respectively, had remained abstinent (P=.003). <h3>Conclusion:</h3> Acamprosate proved to be a safe and effective aid in treating alcohol-dependent patients and in maintaining the abstinence of patients during 2 years.