Efficacy of Disulfiram for the Treatment of Alcohol Dependence Assessed with a Multicenter Randomized Controlled Trial

Background The efficacy of disulfiram in preventing an alcoholic relapse has been controversial. The aim of our study was to assess the efficacy of supervised disulfiram for the treatment of alcohol dependence with a multi‐institutional study in Japan. Methods In a single‐blinded, randomized placebo...

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Published in:	Alcoholism, clinical and experimental research Vol. 38; no. 2; pp. 572 - 578
Main Authors:	Yoshimura, Atsushi, Kimura, Mitsuru, Nakayama, Hisakazu, Matsui, Toshifumi, Okudaira, Fukiko, Akazawa, Shigeru, Ohkawara, Masao, Cho, Tetsuji, Kono, Yoshihiro, Hashimoto, Koji, Kumagai, Masayuki, Sahashi, Yukiko, Roh, Sungwon, Higuchi, Susumu
Format:	Journal Article
Language:	English
Published:	England Blackwell Publishing Ltd 01-02-2014 Wiley Subscription Services, Inc
Subjects:	Adult Age of Onset Aged Alcohol Dependence Alcohol Deterrents - therapeutic use Alcoholism - complications Alcoholism - drug therapy Aldehyde Dehydrogenase - genetics ALDH2 Disulfiram Disulfiram - therapeutic use Efficacy Hospitalization - statistics & numerical data Humans International Classification of Diseases Japan Kaplan-Meier Estimate Liver Function Tests Male Mental Disorders - epidemiology Mental Disorders - etiology Middle Aged Randomized Controlled Trial Single-Blind Method Socioeconomic Factors Survival Analysis Treatment Outcome Young Adult Japan Disulfiram Efficacy Alcohol Dependence ALDH2 Randomized Controlled Trial
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Summary:	Background The efficacy of disulfiram in preventing an alcoholic relapse has been controversial. The aim of our study was to assess the efficacy of supervised disulfiram for the treatment of alcohol dependence with a multi‐institutional study in Japan. Methods In a single‐blinded, randomized placebo‐controlled study, we recruited 109 patients diagnosed with alcohol dependence under ICD‐10 criteria. The patients were randomly allocated to 4 treatment groups, depending on whether they took disulfiram (200 mg daily) or a placebo or whether they received adjunctive therapy consisting of mailed letters which delineated and emphasized the harmful effect of alcohol and the management of alcohol craving. The proportion of abstinence among the 4 groups at 26 weeks after discharge was the primary outcome measure. The proportion of abstinence was compared with the severity of alcohol dependence and craving. Furthermore, we examined the proportion of abstinence in patients with inactive aldehyde dehydrogenase‐2 (ALDH2). Results There were no significant differences among the 4 groups in terms of abstinent patients or study dropouts. The ratio of abstinence was not related to the severity of alcohol dependence or the degree of alcohol craving. Patients with inactive ALDH2 significantly sustained abstinence with the use of disulfiram (p = 0.044). Conclusions Supervised oral disulfiram use followed by intervention via letters seems to be ineffective for increasing abstinence. Further studies are necessary to prove the efficacy of disulfiram for the pharmacological treatment of alcohol dependence. We indicated the effectiveness of disulfiram for the maintenance of abstinence in patients with inactive ALDH2.
Bibliography:	ArticleID:ACER12278 istex:247082917107506087411EE29703697C4E729273 ark:/67375/WNG-Q34NGKSS-D Health Labour Sciences Research Grant, Japan ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-News-2 ObjectType-Feature-3 content type line 23
ISSN:	0145-6008 1530-0277
DOI:	10.1111/acer.12278