The following is a summary of “Topiramate Versus Naltrexone for Alcohol Use Disorder: A Genotype-Stratified Double-Blind Randomized Controlled Trial,” published in the May 2024 issue of Psychiatry by Morley et al.

There are weak comparative and controlled trials between topiramate and other alcohol use disorders (AUD), such as naltrexone. The research is also unclear on how two specific gene polymorphisms, rs2832407 (GRIK1) and rs1799971 (OPRM1), affect responses to topiramate and naltrexone. 

Researchers conducted a prospective study to compare how well topiramate and naltrexone improve AUD outcomes and see how the rs2832407 and rs1799971 polymorphisms influence the response to these medications. 

They conducted a 12-week, double-blind, placebo-controlled, randomized trial with 147 patients with AUD. Participants were given either topiramate or naltrexone, stratified by genotype (rs2832407*CC and *AC/AA genotypes and rs1799971*AA abd *AG/GG genotypes). The primary outcome was heavy drinking days per week, with secondary outcomes including drinks per day, body mass index (BMI), craving, liver markers, mood, and adverse events. 

The results showed a near-significant time-by-treatment interaction for heavy drinking days per week. Topimarate significantly reduced standard drinks per drinking day per week compared to naltrexone. Topiramate also considerably reduced BMI, craving, and gamma-glutamyltransferase levels. Side effect withdrawals were 8% for topiramate and 5% for naltrexone. Neither polymorphism affected treatment response. 

Investigators concluded that topiramate matches naltrexone in cutting down heavy drinking and surpasses it in some outcomes. The genetic variations, rs2832407, and rs1799971, don’t influence how effective topiramate or naltrexone is, respectively.

Source: ajp.psychiatryonline.org/doi/10.1176/appi.ajp.20230666