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Predictors of acamprosate efficacy: results from a pooled analysis of seven European trials including 1485 alcohol-dependent patients

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Abstract

Rationale

Acamprosate is a proven effective intervention in the treatment of alcohol dependence. However, acamprosate prevents lapses or relapses only in a minority of patients. An important question, therefore, is whether there is a specific subgroup of patients who respond particularly well to acamprosate.

Objectives

To identify predictors of acamprosate efficacy. Based upon the available evidence and hypotheses about the mechanisms underlying acamprosate’s effects on drinking behavior, the following variables were considered to be potential positive predictors: high physiological dependence at baseline, negative family history of alcoholism, late age-of-onset, serious anxiety symptomatology at baseline, severe craving at baseline, and female gender.

Method

Potential predictors of acamprosate’s efficacy were analyzed in a pooled analysis of data from seven randomized placebo-controlled trials involving a total of 1485 patients with alcohol dependence. Outcome is measured in terms of cumulative abstinence duration (CAD), continuous abstinence (ABST), and time to first relapse (TFR).

Results

CAD and ABST were predicted by baseline measures of craving and anxiety, as well as by study and treatment condition. Acamprosate efficacy was not differentially associated with any of the predictor variables. Importantly, the hypotheses were rejected despite the large sample size and sufficient statistical power.

Comment

The most straight-forward clinical implication of this study is that acamprosate can be considered as a potentially effective pharmacotherapy for all patients with alcohol dependence. The effect size of acamprosate alone is, however, moderate. Some evidence indicates that the combination of acamprosate with naltrexone or disulfiram leads to substantially better outcomes.

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Acknowledgements

Merck-Lipha, France, provided data and statistical support, and covered the costs for meetings between the researchers. The clinical trials included in this meta-analysis comply with the current laws in the respective countries in which they were conducted.

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Authors and Affiliations

  1. Department of Clinical Psychology, University of Amsterdam , Amsterdam, The Netherlands

    Roel Verheul

  2. Viersprong Institute for Studies on Personality Disorder (VISPD), Center of Psychotherapy “De Viersprong”, PO Box 7, 4660 AA, Halsteren, The Netherlands

    Roel Verheul

  3. Faculty of Medicine, Melbourne, Australia

    Philippe Lehert

  4. Faculty of Economics, Mons, Belgium

    Philippe Lehert

  5. The Jellinek Clinic, Amsterdam, The Netherlands

    Peter J. Geerlings

  6. Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

    Peter J. Geerlings, Maarten W. J. Koeter & Wim van den Brink

  7. Amsterdam Institute of Addiction Research, Amsterdam, The Netherlands

    Maarten W. J. Koeter & Wim van den Brink

Authors
  1. Roel Verheul
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  2. Philippe Lehert
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  3. Peter J. Geerlings
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  4. Maarten W. J. Koeter
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  5. Wim van den Brink
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Correspondence to Roel Verheul.

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Verheul, R., Lehert, P., Geerlings, P.J. et al. Predictors of acamprosate efficacy: results from a pooled analysis of seven European trials including 1485 alcohol-dependent patients. Psychopharmacology 178, 167–173 (2005). https://doi.org/10.1007/s00213-004-1991-7

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  • DOI: https://doi.org/10.1007/s00213-004-1991-7

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