Key Points

Question: Which pharmacotherapies are associated with improved outcomes for people with alcohol use disorder?

Findings: In this systematic review and meta-analysis that included 118 clinical trials and 20 976 participants, 50 mg/d of oral naltrexone and acamprosate were each associated with significantly improved alcohol consumption-related outcomes compared with placebo.

Meaning:  These findings support oral naltrexone at 50 mg/d and acamprosate as first-line therapies for alcohol use disorder.


Objective: To compare efficacy and comparative efficacy of therapies for alcohol use disorder.

Study Selection: For efficacy outcomes, randomized clinical trials of at least 12 weeks’ duration were included. For adverse effects, randomized clinical trials and prospective cohort studies that compared drug therapies and reported health outcomes or harms were included.

Main Outcomes and Measures: The primary outcome was alcohol consumption. Secondary outcomes were motor vehicle crashes, injuries, quality of life, function, mortality, and harms.

Conclusions and Relevance:  In conjunction with psychosocial interventions, these findings support the use of oral naltrexone at 50 mg/d and acamprosate as first-line pharmacotherapies for alcohol use disorder.

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