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Efficacy and Tolerability of Long-Acting Injectable Naltrexone for Alcohol Dependence
A Randomized Controlled Trial
James C. Garbutt, MD;
Henry R. Kranzler, MD;
Stephanie S. O’Malley, PhD;
David R. Gastfriend, MD;
Helen M. Pettinati, PhD;
Bernard L. Silverman, MD;
John W. Loewy, PhD;
Elliot W. Ehrich, MD; for the Vivitrex Study Group
JAMA. 2005;293:1617-1625.
Context Alcohol dependence is a common disorder associated with significant morbidity and mortality. Naltrexone, an opioid antagonist, has been shown to be effective for treatment of alcohol dependence. However, adherence to daily oral pharmacotherapy can be problematic, and clinical acceptance and utility of oral naltrexone have been limited.
Objective To determine efficacy and tolerability of a long-acting intramuscular formulation of naltrexone for treatment of alcohol-dependent patients.
Design, Setting, and Participants A 6-month, randomized, double-blind, placebo-controlled trial conducted between February 2002 and September 2003 at 24 US public hospitals, private and Veterans Administration clinics, and tertiary care medical centers. Of the 899 individuals screened, 627 who were diagnosed as being actively drinking alcohol-dependent adults were randomized to receive treatment and 624 received at least 1 injection.
Intervention An intramuscular injection of 380 mg of long-acting naltrexone (n = 205) or 190 mg of long-acting naltrexone (n = 210) or a matching volume of placebo (n = 209) each administered monthly and combined with 12 sessions of low-intensity psychosocial intervention.
Main Outcome Measure The event rate of heavy drinking days in the intent-to-treat population.
Results Compared with placebo, 380 mg of long-acting naltrexone resulted in a 25% decrease in the event rate of heavy drinking days (P = .03) and 190 mg of naltrexone resulted in a 17% decrease (P = .07). Sex and pretreatment abstinence each showed significant interaction with the medication group on treatment outcome, with men and those with lead-in abstinence both exhibiting greater treatment effects. Discontinuation due to adverse events occurred in 14.1% in the 380-mg and 6.7% in the 190-mg group and 6.7% in the placebo group. Overall, rate and time to treatment discontinuation were similar among treatment groups.
Conclusions Long-acting naltrexone was well tolerated and resulted in reductions in heavy drinking among treatment-seeking alcohol-dependent patients during 6 months of therapy. These data indicate that long-acting naltrexone can be of benefit in the treatment of alcohol dependence.
Author Affiliations: Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill (Dr Garbutt), Department of Psychiatry, University of Connecticut School of Medicine, Farmington (Dr Kranzler), Department of Psychiatry, Yale University School of Medicine, New Haven, Conn (Dr O’Malley), Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Dr Gastfriend), Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia (Dr Pettinati), Alkermes Inc, Cambridge, Mass (Drs Silverman, Loewy, and Ehrich). Dr Gastfriend is now with Alkermes Inc.
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