Hospitalized patients with alcohol use disorder (AUD) who received either daily oral or extended-release injectable naltrexone upon discharge experienced similar reductions in heavy drinking days, according to a report in JAMA Internal Medicine. Acute and alcohol-related health care utilization after 90 days were also not significantly different between the two groups.
For this reason, the choice of oral versus injectable naltrexone should be driven by practical considerations, and adherence may improve with flexibility in patient choice of treatment, wrote Kara S. Magane, M.S., of Boston University School of Public Health, and colleagues. “In clinical practice, the most effective medication may vary based on patient preference, availability, cost, and post-discharge follow-up logistics.”
The researchers analyzed data on 248 hospitalized patients (80.2% male) with AUD as part of the Alcohol Disorder Hospital Treatment (ADOPT) study, a randomized clinical trial conducted at an urban teaching hospital between June 2016 and March 2020. Participants received either 30 days of oral naltrexone or an injection of monthly naltrexone upon discharge; medications were resupplied during monthly medical management visits with a research nurse who specialized in addiction.
The primary outcome, assessed at three-month follow-up, was change in percentage of heavy drinking days (HDDs) over the previous 30 days. An HDD was defined as five drinks or more per day for males and four drinks or more for females. The secondary outcome was any emergency department use or hospitalization over the previous 90 days.
The average percentage of heavy drinking days over 30 days was reduced in the oral naltrexone group from 66.7% at baseline to 27.4% at follow-up and from 70.7% at baseline in the extended-release naltrexone group to 23.8% at follow-up; the difference between groups was not statistically significant.
The odds of emergency department (ED) use or hospitalization was also not statistically different: At follow-up, 54.1% of participants in the oral naltrexone group and 61.1% of those in the extended-release naltrexone group reported a hospitalization or ED visit in the prior 90 days.
“By addressing AUD in hospitalized patients, care can potentially yield better overall health outcomes,” the researchers concluded. “Given the evidence that AUD medication provided in the hospital helps to reduce HDDs, future trials should assess optimal implementation of this strategy from clinician, patient, and payer perspectives.”
For related information, see the Psychiatric News article “APA Releases Practice Guideline for AUD Pharmacotherapy” and the Psychiatric News Special Report “Psychiatrists Critical in Screening, Treatment of Alcohol Use Disorder.”
(Image: Getty Images/iStock/AndreyCherkasov)
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