Oral, injectable naltrexone at discharge similarly effective for alcohol use disorder

Key takeaways:

• Adults with alcohol use disorder who were given either form of naltrexone had reduced heavy drinking days.
• Both forms of naltrexone were linked to similar risk for hospital or ED visit.

Adults who were given oral naltrexone at hospital discharge experienced a similar decrease in heavy drinking days as adults given extended-release injectable naltrexone, according to a study published in JAMA Internal Medicine.

In the U.S. approximately 8% of people aged 12 years or older have alcohol use disorder (AUD), but a majority (94%) will never receive medication or counseling, Kara M. Magane, MS, senior director of research operations at the Boston University School of Public Health, and colleagues wrote.

Initiating AUD medication at hospital discharge may improve delivery and outcomes, the researchers continued, with a recent survey by Hearne and colleagues showing that 19% of inpatients have AUD.

Naltrexone is the most commonly used AUD medication and is available as an oral daily tablet or monthly injection. However, researchers have not investigated if these delivery methods produce different outcomes in this setting.

This inspired the researchers to perform the open-label randomized Alcohol Disorder Hospital Treatment (ADOPT) study to compare the effectiveness of initiating oral vs. extended-release injectable naltrexone on reduction in alcohol use among inpatients with AUD.

Magane and colleagues recruited participants from an urban academic hospital in the U.S. from June 2016 to March 2020 based on clinical referral or medical record review. The analysis included 248 adults (80.2% men; mean age, 49.4 years; standard deviation [SD], 10.4 years) with AUD who had 1 or more heavy drinking days (HDDs), defined as five or more drinks for men and four or more drinks for women, in the month prior to hospitalization.

The primary endpoint of the study was change in percentage of self-reported HDDs over the past 30 days from baseline to 3-month follow-up.

Researchers randomly assigned 125 adults to the oral naltrexone group and 123 to the extended-release injectable naltrexone group. Both arms received medical management from a nurse who specialized in addiction.

Overall, 217 participants completed the 3-month follow-up.

The researchers found that participants who received either medication experienced a decrease in mean percentage of HDDs in the month prior from baseline to follow-up.

In the oral naltrexone arm, the mean percentage of HDDs in the past 30 days fell from 66.7% at baseline to 27.4% at 3-month follow-up, equating to a difference of 38.4 percentage points (95% CI, 125 to 48.2).

Similarly, in the extended-release group, the mean percentage of HDDs in the past 30 days decreased from 70.7% to 23.8%, for a difference of 46.4 percentage points (95% CI, –123.4 to 30.6).

Although the extended-release injectable naltrexone group experienced greater reductions in percentage of HDDs compared with the oral naltrexone group, the researchers did not consider this difference to be significant.

Magane and colleagues additionally investigated any self-reported acute health care treatment related to alcohol use over the study period, including ED visits and hospitalizations, as a secondary outcome. With 54.1% of the oral naltrexone group and 61.1% of the injectable naltrexone group reporting a hospitalization/ED visit during the study period, a multivariable regression model adjusted for sex and race showed the injectable naltrexone group was not significantly more likely to be hospitalized or visit the ED (adjusted OR = 1.34; 95% CI, 0.77-2.33).

The researchers noted several limitations to this study, including the gender imbalance of the population and potential recall and social desirability bias introduced through self-reported data.

“By addressing AUD in hospitalized patients, care can potentially yield better overall health outcomes,” Magane and colleagues wrote.

“Additionally, since both medications were similarly effective, decisions on which medication may produce the best patient outcomes may be determined by considering patient preferences, costs, insurance and access to outpatient follow-up,” they added.

Reference:

• Hearne R, et al. J R Soc Med. 2002;doi:10.1177/014107680209500208.