Oral as good as extended-release injectable naltrexone for hospitalized adults with AUD

For hospitalized individuals initiating treatment for alcohol use disorder (AUD), oral naltrexone is equally efficacious as the extended-release injectable formulation in terms of reducing heavy drinking days, as shown in a study.

The study included 248 inpatients (mean age 49.4 years, 80.2 percent male) with AUD and recent heavy drinking (defined as at least five drinks for men and at least four drinks for women). These participants were randomly assigned to treatment with either daily oral naltrexone or monthly extended-release injectable naltrexone. All of them received medical management with a research nurse who specialized in addiction.

Change in percentage of heavy drinking days in the past 30 days from baseline to 3-month follow-up was assessed as the primary outcome. Any acute healthcare utilization (emergency department or hospitalization) at 3-month follow-up over the past 90 days was the secondary outcome.

The percentage of heavy drinking days in the past 30 days decreased in both treatment arms. At the 3-month follow-up, the mean percentage of heavy drinking days in the past 30 days dropped from 66.7 percent at baseline to 27.4 percent in the oral naltrexone arm (difference, −38.4 percentage points, 95 percent confidence interval [CI], −125.0 to 48.2) and from 70.7 percent to 23.8 percent in the extended-release injectable arm (difference, −46.4 percentage points, 95 percent CI, −123.4 to 30.6). The difference between the treatment arms was not significant (p=0.14).

At follow-up, healthcare utilization in the prior 3 months was documented in 54.1 percent of participants in the oral naltrexone arm and in 61.1 percent of those in the extended-release injectable naltrexone arm. The difference did not reach significance (adjusted odds ratio, 1.34, 95 percent CI, 0.77–2.33).