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Bonfils NA, Aubin HJ, Grall-Bronnec M, Caillon J, Perney P, Limosin F, Luquiens A. Development and Psychometric Properties of a New Patient-Reported Outcome Instrument of Health-Related Quality of Life Specific to Patients with Gambling Disorder: The Gambling Quality of Life Scale (GQoLS). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10806. [PMID: 36078519 PMCID: PMC9517863 DOI: 10.3390/ijerph191710806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/23/2022] [Accepted: 08/24/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Impairment or distress caused by gambling disorder can be subjectively assessed via quality of life. The aim of this study was to develop a new patient-reported outcome instrument to explore the health-related quality of life (HRQoL) in gambling disorders, the Gambling quality-of-life scale (GQoLS), and to document its psychometric properties. METHODS A previous qualitative study had been conducted using focus groups of problem gamblers to identify areas of HRQoL impacted by gambling. The seven domains identified served as the basis for the hypothetical structure of GQoLS. Draft items were generated from the patient's speeches to illustrate each of these domains. Cognitive debriefing interviews were realized to obtain a final hypothetical GQoLS. A validation study was then carried out to determine the final version of GQoLS and its psychometric properties (structural validity, construct validity, internal consistency). RESULTS The final GQoLS was composed of 21 items, with a total mean score of 38.3 (±13.6). Structural validity found a major dimension and four other minor dimensions. The five dimensions were: "emotion", "lifestyle", "loneliness", "taboo" and "preoccupation". GQoLS was moderately to strongly correlated with PGSI and EQ-5D visual analogic scale. Cronbach's alpha coefficient was 0.92. CONCLUSION GQoLS is the first HRQoL instrument specific to patients with a gambling disorder and developed from the patient's perspective. GQoLS presents good psychometric properties. GQoLS can be used in clinical research to demonstrate the effectiveness of an intervention on outcomes that are relevant from the patient's perspective.
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Affiliation(s)
- Nicolas A. Bonfils
- CESP, UVSQ, INSERM, Université Paris-Saclay, 94804 Villejuif, France
- Department of Psychiatry and Addictology, Assistance Publique-Hopitaux de Paris, Hôpitaux Universitaires Paris Ouest, 92130 Issy-les-Moulineaux, France
- Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, 75000 Paris, France
- Inserm, U894, Centre Psychiatrie et Neurosciences, 75013 Paris, France
| | - Henri-Jean Aubin
- CESP, UVSQ, INSERM, Université Paris-Saclay, 94804 Villejuif, France
- Assistance Publique-Hopitaux de Paris, Hôpitaux Universitaires Paris-Sud, 94804 Villejuif, France
- Faculté de Médecine Paris Sud, Université Paris XI, 91405 Orsay, France
| | - Marie Grall-Bronnec
- Addictology and Psychiatry Department, CHU Nantes, 44093 Nantes, France
- Inserm, U1246, Université de Nantes, Université de Tours, 44093 Nantes, France
| | - Julie Caillon
- Addictology and Psychiatry Department, CHU Nantes, 44093 Nantes, France
- Inserm, U1246, Université de Nantes, Université de Tours, 44093 Nantes, France
| | - Pascal Perney
- CESP, UVSQ, INSERM, Université Paris-Saclay, 94804 Villejuif, France
- Department of Addictions, CHU Nîmes, Université de Montpellier, 30000 Nîmes, France
| | - Frédéric Limosin
- Department of Psychiatry and Addictology, Assistance Publique-Hopitaux de Paris, Hôpitaux Universitaires Paris Ouest, 92130 Issy-les-Moulineaux, France
- Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, 75000 Paris, France
- Inserm, U894, Centre Psychiatrie et Neurosciences, 75013 Paris, France
| | - Amandine Luquiens
- CESP, UVSQ, INSERM, Université Paris-Saclay, 94804 Villejuif, France
- Assistance Publique-Hopitaux de Paris, Hôpitaux Universitaires Paris-Sud, 94804 Villejuif, France
- Faculté de Médecine Paris Sud, Université Paris XI, 91405 Orsay, France
- Department of Addictions, CHU Nîmes, Université de Montpellier, 30000 Nîmes, France
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Aubin HJ, Dureau-Pournin C, Falissard B, Paille F, Rigaud A, Micon S, Pénichon M, Andersohn F, Truchi C, Blin P. Use of Nalmefene in Routine Practice: Results from a French Prospective Cohort Study and a National Database Analysis. Alcohol Alcohol 2021; 56:545-555. [PMID: 33969378 PMCID: PMC8406069 DOI: 10.1093/alcalc/agab029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 02/22/2021] [Accepted: 03/20/2021] [Indexed: 11/13/2022] Open
Abstract
Aims Two complementary studies were used to assess the real-life use of nalmefene in alcohol-dependent patients and its impact on alcohol use health status. Methods USE-PACT was a prospective cohort study designed to evaluate the real-life effectiveness of nalmefene in the management of alcohol dependence, as assessed by total alcohol consumption (TAC) and number of heavy drinking days (HDD) at 1 year. USE-AM was a cohort study using data from the French nationwide claims database and was used to evaluate the external validity of the population in the prospective study. Results Overall, 256 of 700 new nalmefene users enrolled in the USE-PACT study had valid data at 1 year. After 1 year, patients treated with nalmefene showed a mean ± SD reduction from baseline in TAC (−41.5 ± 57.4 g/day) and number of HDD (−10.7 ± 11.7 days/4 weeks). Patients took a mean ± SD of 20.0 ± 12.0 tablets/4 weeks (median of 1 tablet/day) for the first 3 months and then reduced the dose. The proportion of patients who no longer took nalmefene gradually increased from 5% at 1 month to 52% at 1 year. The USE-AM study identified 486 patients with a first reimbursement for nalmefene in 2016; baseline characteristics confirmed external validity of the USE-PACT study. Overall, 46.3% of initial USE-AM prescriptions were made by GPs; most (91.8%) patients stopped treatment during follow-up. However, 15.2% of patients resumed treatment after stopping. Conclusions In this analysis of French routine practice, patients with alcohol dependence treated with nalmefene showed reduced alcohol consumption, and nalmefene was generally well tolerated.
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Affiliation(s)
- Henri-Jean Aubin
- Université Paris-Saclay, Inserm, CESP, AP-HP. Université Paris Saclay, 12, avenue Paul-Vaillant-Couturier, 94804 Villejuif, France
| | - Caroline Dureau-Pournin
- Université de Bordeaux, INSERM CIC-P 1401, Bordeaux PharmacoEpi, Rue Eugène Jacquet, Bordeaux 33000, France
| | - Bruno Falissard
- CESP/INSERM U1018, Centre de Recherche en Epidémiologie et Santé des Populations, Hôpital Paul Brousse Bat 15/16, 16 av PV Couturier - 94807 Villejuif, France
| | - François Paille
- Université de Lorraine, 34 Cours Léopold, 54000 Nancy, France
| | - Alain Rigaud
- Ancien chef du pôle d'Addictologie de l'EPSM Marne, Psychiatre des hôpitaux honoraire, 28 bis, rue de Courcelles 51100 Reims, France
| | - Sophie Micon
- Université de Bordeaux, INSERM CIC-P 1401, Bordeaux PharmacoEpi, Rue Eugène Jacquet, Bordeaux 33000, France
| | - Marine Pénichon
- Université de Bordeaux, INSERM CIC-P 1401, Bordeaux PharmacoEpi, Rue Eugène Jacquet, Bordeaux 33000, France
| | - Frank Andersohn
- Frank Andersohn Consulting and Research Services, Mandelstrasse 16, 10409 Berlin, Germany
| | - Christine Truchi
- Lundbeck SAS, 102 Terrasse Boieldieu 92085 Paris La Défense, France
| | - Patrick Blin
- Université de Bordeaux, INSERM CIC-P 1401, Bordeaux PharmacoEpi, Rue Eugène Jacquet, Bordeaux 33000, France
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Bonfils NA, Grall-Bronnec M, Caillon J, Limosin F, Benyamina A, Aubin HJ, Luquiens A. Giving room to subjectivity in understanding and assessing problem gambling: A patient-centered approach focused on quality of life. J Behav Addict 2019; 8:103-113. [PMID: 30663328 PMCID: PMC7044609 DOI: 10.1556/2006.7.2018.137] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND AND AIMS Problem gambling is characterized by high stigma and self-stigma, making relevant measurement of the burden of the disorder complex. The aim of our qualitative study was to describe health-related quality of life (HRQOL) impacted by problem gambling from the patients' perspective. METHODS We conducted 6 focus groups with 25 current or lifetime at-risk problem gamblers to identify key domains of quality of life impacted by problem gambling. A content analysis from the focus groups data was conducted using Alceste© software, using descendant hierarchical classification analysis, to obtain stable classes and the significant presences of reduced forms. The class of interest, detailing the core of impacted quality of life, was described using a cluster analysis. RESULTS Thematic content analysis identified three stable classes. Class 1 contained the interviewers' speech. Class 3 was composed of the vocabulary related to gambling practice, games and gambling venues (casino, horse betting, etc.). Class 2 described the core of impact of gambling on quality of life and corresponded to 43% of the analyzed elementary context units. This analysis revealed seven key domains of impact of problem gambling: loneliness, financial pressure, relationships deterioration, feeling of incomprehension, preoccupation with gambling, negative emotions, and avoidance of helping relationships. CONCLUSIONS We identified, beyond objective damage, the subjective distress felt by problem gamblers over the course of the disorder and in the helping process, marked in particular by stigma and self-stigma. Four impacted HRQOL areas were new and gambling-specific: loneliness, feeling of incomprehension, avoidance of helping relationships, and preoccupation with gambling. These results support the relevance of developing, in a next step, a specific HRQOL scale in the context of gambling.
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Affiliation(s)
- Nicolas A. Bonfils
- CESP, UVSQ, INSERM, University Paris-Sud, Université Paris-Saclay, Villejuif, France,Inserm U894, Centre Psychiatrie et Neurosciences, Paris, France,AP-HP, Department of Psychiatry and Addictology, Hôpitaux Universitaires Paris Ouest, Paris, France,Sorbonne Paris Cité, Faculté de Médecine, Université Paris Descartes, Paris, France,Corresponding author: Nicolas A. Bonfils; Inserm U894, Centre Psychiatrie et Neurosciences, Issy-Les-Moulineaux, Paris 92130, France; Phone: +33 6 37 29 40 15; Fax: +33 1 71 19 63 72; E-mail:
| | - Marie Grall-Bronnec
- Addictology and Psychiatry Department, CHU Nantes, Nantes, France,Université de Tours, Inserm U1246, Université de Nantes, Nantes, France
| | - Julie Caillon
- Addictology and Psychiatry Department, CHU Nantes, Nantes, France,Université de Tours, Inserm U1246, Université de Nantes, Nantes, France
| | - Frédéric Limosin
- Inserm U894, Centre Psychiatrie et Neurosciences, Paris, France,AP-HP, Department of Psychiatry and Addictology, Hôpitaux Universitaires Paris Ouest, Paris, France,Sorbonne Paris Cité, Faculté de Médecine, Université Paris Descartes, Paris, France
| | - Amine Benyamina
- CESP, UVSQ, INSERM, University Paris-Sud, Université Paris-Saclay, Villejuif, France,APHP, Hôpitaux Universitaires Paris-Sud, Villejuif, France,Faculté de Médecine Paris Sud, Université Paris XI, Paris, France
| | - Henri-Jean Aubin
- CESP, UVSQ, INSERM, University Paris-Sud, Université Paris-Saclay, Villejuif, France,APHP, Hôpitaux Universitaires Paris-Sud, Villejuif, France,Faculté de Médecine Paris Sud, Université Paris XI, Paris, France
| | - Amandine Luquiens
- CESP, UVSQ, INSERM, University Paris-Sud, Université Paris-Saclay, Villejuif, France,APHP, Hôpitaux Universitaires Paris-Sud, Villejuif, France,Faculté de Médecine Paris Sud, Université Paris XI, Paris, France
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Naudet F, Palpacuer C, Boussageon R, Laviolle B. Evaluation in alcohol use disorders - insights from the nalmefene experience. BMC Med 2016; 14:119. [PMID: 27534932 PMCID: PMC4989362 DOI: 10.1186/s12916-016-0664-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Accepted: 07/28/2016] [Indexed: 11/26/2022] Open
Abstract
Nalmefene was the first treatment approved by the European Medicines Agency for reducing alcohol consumption in adult patients with alcohol dependence. It is often presented as a paradigm shift in therapeutics, but major issues limit the interpretation of the evidence supporting its use. The randomised trials submitted provided no evidence of harm reduction, the differences on consumption outcomes were of questionable clinical relevance, the target population was defined a posteriori and the drug was compared to a placebo although naltrexone was already used off-label. No post-approval randomised study is currently designed to clearly address these issues. In addition, nalmefene trials have been uncritically cited, even in guidelines. This experience reveals weaknesses in drug evaluations in alcohol dependence, which call for changes. We propose to dispense with alcohol consumption as a surrogate outcome, to consider comparative effectiveness issues, and to recommend randomised post-approval studies in case of controversial approval.
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Affiliation(s)
- Florian Naudet
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, 1070 Arastradero Road, Palo Alto, CA, 94304, USA.
| | - Clément Palpacuer
- INSERM Centre d'Investigation Clinique 1414, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Rémy Boussageon
- Département de Médecine Générale, Faculté de Médecine de Poitiers, Poitiers, France
| | - Bruno Laviolle
- INSERM Centre d'Investigation Clinique 1414, Centre Hospitalier Universitaire de Rennes, Rennes, France
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Fitzgerald N, Angus K, Elders A, de Andrade M, Raistrick D, Heather N, McCambridge J. Weak evidence on nalmefene creates dilemmas for clinicians and poses questions for regulators and researchers. Addiction 2016; 111:1477-87. [PMID: 27262594 PMCID: PMC5089629 DOI: 10.1111/add.13438] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 12/15/2015] [Accepted: 04/21/2016] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND AIMS Nalmefene has been approved in Europe for the treatment of alcohol dependence and subsequently recommended by the UK National Institute for Health and Care Excellence (NICE). This study examines critically the evidence base underpinning both decisions and the issues arising. METHODS Published studies of nalmefene were identified through a systematic search, with documents from the European Medicines Agency, the NICE appraisal and public clinical trial registries also examined to identify methodological issues. RESULTS Efficacy data used to support the licensing of nalmefene suffer from risk of bias due to lack of specification of a priori outcome measures and sensitivity analyses, use of post-hoc sample refinement and the use of inappropriate comparators. Despite this, evidence for the efficacy of nalmefene in reducing alcohol consumption in those with alcohol dependence is, at best, modest, and of uncertain significance to individual patients. The relevance of existing trial data to routine primary care practice is doubtful. CONCLUSIONS Problems with the registration, design, analysis and reporting of clinical trials of nalmefene did not prevent it being licensed and recommended for treating alcohol dependence. This creates dilemmas for primary care clinicians and commissioning organisations where nalmefene has been heavily promoted, and poses wider questions about the effectiveness of the medicines regulation system and how to develop the alcohol treatment evidence base.
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Affiliation(s)
- Niamh Fitzgerald
- Institute for Social Marketing, UK Centre for Tobacco Alcohol StudiesUniversity of StirlingScotlandUK
| | - Kathryn Angus
- Institute for Social Marketing, UK Centre for Tobacco Alcohol StudiesUniversity of StirlingScotlandUK
| | | | - Marisa de Andrade
- School of Health in Social ScienceUniversity of EdinburghEdinburghScotlandUK
| | | | - Nick Heather
- Department of Psychology, Faculty of Health and Life SciencesNorthumbria UniversityNewcastle upon TyneUK
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Rolland B, Paille F, Gillet C, Rigaud A, Moirand R, Dano C, Dematteis M, Mann K, Aubin H. Pharmacotherapy for Alcohol Dependence: The 2015 Recommendations of the French Alcohol Society, Issued in Partnership with the European Federation of Addiction Societies. CNS Neurosci Ther 2016; 22:25-37. [PMID: 26768685 PMCID: PMC6492872 DOI: 10.1111/cns.12489] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Revised: 10/30/2015] [Accepted: 11/03/2015] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The latest French good practice recommendations (GPRs) for the screening, prevention, and treatment of alcohol misuse were recently published in partnership with the European Federation of Addiction Societies (EUFAS). This article aims to synthesize the GPRs focused on the pharmacotherapy of alcohol dependence. METHODS A four-member European steering committee defined the questions that were addressed to an 18-member multiprofessional working group (WG). The WG developed the GPRs based on a systematic, hierarchical, and structured literature search and submitted the document to two review processes involving 37 French members from multiple disciplines and 5 non-French EUFAS members. The final GPRs were graded A, B, or C, or expert consensus (EC) using a reference recommendation grading system. RESULTS The treatment of alcohol dependence consists of either alcohol detoxification or abstinence maintenance programs or drinking reduction programs. The therapeutic objective is the result of a decision made jointly by the physician and the patient. For alcohol detoxification, benzodiazepines (BZDs) are recommended in first-line (grade A). BZD dosing should be guided by regular clinical monitoring (grade B). Residential detoxification is more appropriate for patients with a history of seizures, delirium tremens, unstable psychiatric comorbidity, or another associated substance use disorder (grade B). BZDs are only justified beyond a 1-week period in the case of persistent withdrawal symptoms, withdrawal events or associated BZD dependence (grade B). BZDs should not be continued for more than 4 weeks (grade C). The dosing and duration of thiamine (vitamin B1) during detoxification should be adapted to nutritional status (EC). For relapse prevention, acamprosate and naltrexone are recommended as first-line medications (grade A). Disulfiram can be proposed as second-line option in patients with sufficient information and supervision (EC). For reducing alcohol consumption, nalmefene is indicated in first line (grade A). The second-line prescription of baclofen, up to 300 mg/day, to prevent relapse or reduce drinking should be carried out according to the "temporary recommendation for use" measure issued by the French Health Agency (EC). During pregnancy, abstinence is recommended (EC). If alcohol detoxification is conducted during pregnancy, BZD use is recommended (grade B). No medication other than those for alcohol detoxification should be initiated in pregnant or breastfeeding women (EC). In a stabilized pregnant patient taking medication to support abstinence, the continuation of the drug should be considered on a case-by-case basis, weighing the benefit/risk ratio. Only disulfiram should be always stopped, given the unknown risks of the antabuse effect on the fetus (EC). First-line treatments to help maintain abstinence or reduce drinking are off-label for people under 18 years of age and should thus be considered on a case-by-case basis after the repeated failure of psychosocial measures alone (EC). Short half-life BZDs should be preferred for the detoxification of elderly patients (grade B). The initial doses of BZDs should be reduced by 30 to 50% in elderly patients (EC). In patients with chronic alcohol-related physical disorders, abstinence is recommended (EC). Any antidepressant or anxiolytic medication should be introduced after a psychiatric reassessment after 2-4 weeks of alcohol abstinence or low-risk use (grade B). A smoking cessation program should be offered to any smokers involved in an alcohol treatment program (grade B).
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Affiliation(s)
- Benjamin Rolland
- Société Française d'AlcoologieIssy‐les‐MoulineauxFrance
- Service d'AddictologieCHRU de LilleINSERM U1171Univ LilleLilleFrance
| | - François Paille
- Société Française d'AlcoologieIssy‐les‐MoulineauxFrance
- Service d'AddictologieCHU de NancyVandœuvre‐lès‐NancyNancyFrance
| | - Claudine Gillet
- Société Française d'AlcoologieIssy‐les‐MoulineauxFrance
- Centre d'AddictologieHôpital VilleminNancyFrance
| | - Alain Rigaud
- Société Française d'AlcoologieIssy‐les‐MoulineauxFrance
- Pôle d'addictologieEPSM MarneChâlons‐en‐Champagne et ReimsReimsFrance
- Association Nationale de Prévention en Alcoologie et Addictologue (ANPAA)ParisFrance
| | - Romain Moirand
- Société Française d'AlcoologieIssy‐les‐MoulineauxFrance
- CHU de RennesUnité d'AddictologieRennesFrance
- INSERMUMR 991RennesFrance
| | - Corine Dano
- Société Française d'AlcoologieIssy‐les‐MoulineauxFrance
- Service d'AddictologieCHU d'AngersAngersFrance
| | - Maurice Dematteis
- Société Française d'AlcoologieIssy‐les‐MoulineauxFrance
- Clinique d'AddictologieCHU de GrenobleUniversité Grenoble AlpesGrenobleFrance
| | - Karl Mann
- Central Institute of Mental HealthMedical Faculty MannheimUniversity of HeidelbergMannheimGermany
- EUFAS Scientific Secretariat Professor Antoni Gual (MD; PhD)Clinic Hospital of BarcelonaAddictive Behaviors UnitBarcelonaSpain
| | - Henri‐Jean Aubin
- Société Française d'AlcoologieIssy‐les‐MoulineauxFrance
- EUFAS Scientific Secretariat Professor Antoni Gual (MD; PhD)Clinic Hospital of BarcelonaAddictive Behaviors UnitBarcelonaSpain
- Département de Psychiatrie et d'AddictologieINSERM U1178Hôpital Paul BrousseAPHP VillejuifVillejuifFrance
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Palpacuer C, Laviolle B, Boussageon R, Reymann JM, Bellissant E, Naudet F. Risks and Benefits of Nalmefene in the Treatment of Adult Alcohol Dependence: A Systematic Literature Review and Meta-Analysis of Published and Unpublished Double-Blind Randomized Controlled Trials. PLoS Med 2015; 12:e1001924. [PMID: 26694529 PMCID: PMC4687857 DOI: 10.1371/journal.pmed.1001924] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 11/10/2015] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Nalmefene is a recent option in alcohol dependence treatment. Its approval was controversial. We conducted a systematic review and meta-analysis of the aggregated data (registered as PROSPERO 2014:CRD42014014853) to compare the harm/benefit of nalmefene versus placebo or active comparator in this indication. METHODS AND FINDINGS Three reviewers searched for published and unpublished studies in Medline, the Cochrane Library, Embase, ClinicalTrials.gov, Current Controlled Trials, and bibliographies and by mailing pharmaceutical companies, the European Medicines Agency (EMA), and the US Food and Drug Administration. Double-blind randomized clinical trials evaluating nalmefene to treat adult alcohol dependence, irrespective of the comparator, were included if they reported (1) health outcomes (mortality, accidents/injuries, quality of life, somatic complications), (2) alcohol consumption outcomes, (3) biological outcomes, or (4) treatment safety outcomes, at 6 mo and/or 1 y. Three authors independently screened the titles and abstracts of the trials identified. Relevant trials were evaluated in full text. The reviewers independently assessed the included trials for methodological quality using the Cochrane Collaboration tool for assessing risk of bias. On the basis of the I2 index or the Cochrane's Q test, fixed or random effect models were used to estimate risk ratios (RRs), mean differences (MDs), or standardized mean differences (SMDs) with 95% CIs. In sensitivity analyses, outcomes for participants who were lost to follow-up were included using baseline observation carried forward (BOCF); for binary measures, patients lost to follow-up were considered equal to failures (i.e., non-assessed patients were recorded as not having responded in both groups). Five randomized controlled trials (RCTs) versus placebo, with a total of 2,567 randomized participants, were included in the main analysis. None of these studies was performed in the specific population defined by the EMA approval of nalmefene, i.e., adults with alcohol dependence who consume more than 60 g of alcohol per day (for men) or more than 40 g per day (for women). No RCT compared nalmefene with another medication. Mortality at 6 mo (RR = 0.39, 95% CI [0.08; 2.01]) and 1 y (RR = 0.98, 95% CI [0.04; 23.95]) and quality of life at 6 mo (SF-36 physical component summary score: MD = 0.85, 95% CI [-0.32; 2.01]; SF-36 mental component summary score: MD = 1.01, 95% CI [-1.33; 3.34]) were not different across groups. Other health outcomes were not reported. Differences were encountered for alcohol consumption outcomes such as monthly number of heavy drinking days at 6 mo (MD = -1.65, 95% CI [-2.41; -0.89]) and at 1 y (MD = -1.60, 95% CI [-2.85; -0.35]) and total alcohol consumption at 6 mo (SMD = -0.20, 95% CI [-0.30; -0.10]). An attrition bias could not be excluded, with more withdrawals for nalmefene than for placebo, including more withdrawals for safety reasons at both 6 mo (RR = 3.65, 95% CI [2.02; 6.63]) and 1 y (RR = 7.01, 95% CI [1.72; 28.63]). Sensitivity analyses showed no differences for alcohol consumption outcomes between nalmefene and placebo, but the weight of these results should not be overestimated, as the BOCF approach to managing withdrawals was used. CONCLUSIONS The value of nalmefene for treatment of alcohol addiction is not established. At best, nalmefene has limited efficacy in reducing alcohol consumption.
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Affiliation(s)
- Clément Palpacuer
- INSERM Centre d’Investigation Clinique 1414, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Bruno Laviolle
- INSERM Centre d’Investigation Clinique 1414, Centre Hospitalier Universitaire de Rennes, Rennes, France
- Laboratoire de Pharmacologie Expérimentale et Clinique, Faculté de Médecine, Université de Rennes 1, Rennes, France
| | - Rémy Boussageon
- Département de Médecine Générale, Faculté de Médecine et de Pharmacie, Université de Poitiers, Poitiers, France
| | - Jean Michel Reymann
- INSERM Centre d’Investigation Clinique 1414, Centre Hospitalier Universitaire de Rennes, Rennes, France
- Laboratoire de Pharmacologie Expérimentale et Clinique, Faculté de Médecine, Université de Rennes 1, Rennes, France
| | - Eric Bellissant
- INSERM Centre d’Investigation Clinique 1414, Centre Hospitalier Universitaire de Rennes, Rennes, France
- Laboratoire de Pharmacologie Expérimentale et Clinique, Faculté de Médecine, Université de Rennes 1, Rennes, France
| | - Florian Naudet
- INSERM Centre d’Investigation Clinique 1414, Centre Hospitalier Universitaire de Rennes, Rennes, France
- Laboratoire de Pharmacologie Expérimentale et Clinique, Faculté de Médecine, Université de Rennes 1, Rennes, France
- * E-mail:
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Xie X, Lin W, Xing C, Yang Y, Chi Q, Zhang H, Li Y, Li Z, Yang Y, Yang Z, Li M. In Vitro and In Vivo Evaluations of PLGA Microspheres Containing Nalmefene. PLoS One 2015; 10:e0125953. [PMID: 25938514 PMCID: PMC4418713 DOI: 10.1371/journal.pone.0125953] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 03/27/2015] [Indexed: 11/29/2022] Open
Abstract
Poor patient compliance, untoward reactions and unstable blood drug levels after the bolus administration are impeding the pharmacotherapy for insobriety. A long-acting preparation may address these limitations. The aim of this paper was to further investigate the in vitro characteristics and in vivo performances of nalmefene microspheres. Nalmefene was blended with poly (lactide-co-glycolide) (PLGA) to prepare the target microspheres by an O/O emulsification solvent evaporation method. The prepared microspheres exhibited a controlled release profile of nalmefene in vitro over 4 weeks, which was well fitted with a first-order model. In vitro degradation study showed that the drug release in vitro was dominated by both drug diffusion and polymer degradation mechanisms. Pharmacokinetics study indicated that the prepared microspheres could provide a relatively constant of nalmefene plasma concentration for at least one month in rats. The in vivo pharmacokinetics profile was well correlated with the in vitro drug release. Pharmacodynamics studies revealed that the drug loaded microspheres could produce a long-acting antagonism efficacy on rats. These results demonstrated the promising application of injectable PLGA microspheres containing nalmefene for the long-term treatment of alcohol dependence.
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Affiliation(s)
- Xiangyang Xie
- Department of Pharmacy, Wuhan General Hospital of Guangzhou Military Command, Wuhan, PR China
| | - Wen Lin
- Department of Clinical Laboratory, Huangshi Love & Health Hospital of Hubei province, Huangshi, PR China
| | | | - Yanfang Yang
- Beijing Key Laboratory of Drug Delivery Technology and Novel Formulation, Institute of Materia Medica, Chinese Academy of Medical Sciences & Peking Union Medical college, Beijing, PR China
| | - Qiang Chi
- Department of Pharmacy, The 215th Clinic of 406th Hospital of the Chinese People's Liberation Army, Dalian, PR China
| | - Hui Zhang
- Department of Pharmaceutics, Beijing Institute of Pharmacology and Toxicology, Beijing, PR China
| | - Ying Li
- Department of Pharmaceutics, Beijing Institute of Pharmacology and Toxicology, Beijing, PR China
| | - Zhiping Li
- Department of Pharmaceutics, Beijing Institute of Pharmacology and Toxicology, Beijing, PR China
| | - Yang Yang
- Department of Pharmacy, Wuhan General Hospital of Guangzhou Military Command, Wuhan, PR China
- Department of Pharmaceutics, Beijing Institute of Pharmacology and Toxicology, Beijing, PR China
- * E-mail:
| | - Zhenbo Yang
- Department of Pharmaceutics, Beijing Institute of Pharmacology and Toxicology, Beijing, PR China
| | - Mingyuang Li
- Department of Pharmaceutics, Beijing Institute of Pharmacology and Toxicology, Beijing, PR China
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