Topiramate reduces heavy alcohol intake in people with AUD

Topiramate demonstrates similar efficacy and safety as first-line naltrexone in the management of alcohol use disorder (AUD) and appears to be better in reducing other clinical outcomes, reports a study.

In addition, none of the two polymorphisms—rs2832407 (in GRIK1) and rs1799971 (in OPRM1)—show any marked impact on patient response to topiramate and naltrexone treatments, respectively.

Researchers randomly assigned 147 patients with AUD to treatment with either topiramate or naltrexone, stratified by genotype (rs2832407*CC and *AC/AA genotypes and rs1799971*AA and *AG/GG genotypes), for 12 weeks in this double-blind, placebo-controlled, randomized clinical trial.

The number of heavy drinking days per week served as the predefined primary endpoint. Secondary endpoints were standard drinks per drinking day per week, BMI, craving, markers of liver injury, mood, and adverse events.

A near-significant time-by-treatment interaction was observed for the number of heavy drinking days per week, while a significant time-by-treatment interaction was noted for the number of standard drinks per drinking day per week, favouring topiramate.

Additionally, substantial time-by-treatment effects were also observed for BMI, craving, and gamma-glutamyltransferase level, with greater reductions for topiramate than naltrexone.

Treatment discontinuation due to side effects occurred in 8 percent of patients receiving topiramate and 5 percent of those treated with naltrexone. Neither rs2832407 nor rs1799971 had an effect on treatment response.

“Topiramate is at least as effective and safe as the first-line medication, naltrexone, in reducing heavy alcohol consumption, and superior in reducing some clinical outcomes,” the researchers said.