Combined Efficacy of Acamprosate and Disulfiram in the Treatment of Alcoholism: A Controlled Study

Authors

  • Jacques Besson,

    1. From the Department of Psychiatry, University of Lausanne (J.B., F.A.), and the Bellelay Clinic (A.R), Bellelay, Switzerland; and the Catholic University of Mons (P.L.), Brussels, Belgium; Groupe LIPHA, Lyon, France (A.P.).
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  • François Aeby,

    1. From the Department of Psychiatry, University of Lausanne (J.B., F.A.), and the Bellelay Clinic (A.R), Bellelay, Switzerland; and the Catholic University of Mons (P.L.), Brussels, Belgium; Groupe LIPHA, Lyon, France (A.P.).
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  • Antoine Kasas,

    1. From the Department of Psychiatry, University of Lausanne (J.B., F.A.), and the Bellelay Clinic (A.R), Bellelay, Switzerland; and the Catholic University of Mons (P.L.), Brussels, Belgium; Groupe LIPHA, Lyon, France (A.P.).
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  • Philippe Lehert,

    1. From the Department of Psychiatry, University of Lausanne (J.B., F.A.), and the Bellelay Clinic (A.R), Bellelay, Switzerland; and the Catholic University of Mons (P.L.), Brussels, Belgium; Groupe LIPHA, Lyon, France (A.P.).
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  • Adriaan Potgieter

    1. From the Department of Psychiatry, University of Lausanne (J.B., F.A.), and the Bellelay Clinic (A.R), Bellelay, Switzerland; and the Catholic University of Mons (P.L.), Brussels, Belgium; Groupe LIPHA, Lyon, France (A.P.).
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  • This work was supported in part by state funds and by a grant from Lipha, Inc.

  • The authors thank Dr. A. Fendl for the monitoring of the study and Dr. A. Potgieter for medical reporting.

Reprint requests: Jacques Besson, M.D., Centre Saint Martin Division d'abus de substances, Rue St. Martin 7, CH-1003, Lausanne, Switzerland.

Abstract

This study presents the results of a multicenter investigation of the efficacy of acamprosate in the treatment of patients with chronic or episodic alcohol dependence. One hundred eighteen patients were randomly assigned to either placebo or acamprosate, and both groups were stratified for concomitant voluntary use of disulfiram. Treatment lasted for 380 days, with an additional 360-day follow-up period. The primary efficacy parameters evaluated were: relapse rate and cumulative abstinence duration (CAD). Results were analyzed according to Intention-To-Treat principles using χ2, t, and multiple regression analyses where appropriate. After 30 days on study medication, 40 of 55 (73%) acamprosate-treated patients were abstinent, compared with 26 of 55 (43%) placebo-treated patients (p= 0.019). The treatment advantage remained throughout the study medication period and was statistically significant until day 270 (p= 0.028). Twenty-seven percent of patients on acamprosate and 53% of patients on placebo had a first drink within the first 30 days of the study. The mean CAD was 137 days (40% abstinent days) for the patients treated with acamprosate and 75 days (21% abstinent days) for the placebo group (p= 0.013). No adverse interaction between acamprosate and disulfiram occurred, and the subgroup who received both medications had a better outcome on CAD than the those on only one or no medication. Acamprosate was well tolerated. Diarrhea was the only significant treatment-induced effect. It was concluded that acamprosate was a useful and safe pharmacotherapy in the long-term treatment of alcoholism. Concomitant administration of disulfiram improved the effectiveness of acamprosate.

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