Nancy E. Reid, DHSc, MHA, PA-C, DFAAPA
Purpose: The role of varenicline in alcohol use disorders (AUD) has been of interest since animal models first demonstrated benefit in alcohol consumption. Human clinical trials are mixed. Alcoholism treatment is multifactorial, and success is recognized and positively correlated with motivation. This review examines varenicline’s efficacy in treatment-seeking compared to non-treatment seeking individuals with AUD.
Methods: Review selection includes randomized control trials (RTC) conducted on subjects with AUD and in trials with the ability to determine the percentage of heavy drinking days (PHDD) as the targeted outcome. Medline, PubMed, and the Cochrane Library were utilized to conduct a literature search. Studies are independently chosen and then assessed for quality and meeting inclusion criteria. The trials are divided into two groups, treatment-seeking and non-treatment seeking individuals. Percentage heavy drinking days data are extracted and pooled to calculate the variance of the groups for analysis and significance.
Results: This narrative review includes eight published randomized placebo-controlled trials dating from 2011-2020. Three trials are grouped and described as treatment-seeking participants, while five studies represent a non-treatment seeking cohort. The overall number of participants for treatment-seeking individuals is 320, and for non-treatment seeking subjects is 474. P-values of all works ranged from 0.03 to 0.98. One-Way analysis of variance (ANOVA) was conducted. In aggregate, research does not demonstrate a varenicline effect over placebo for treatment seeking status when applying PHDD as the outcome measure. Dropout rates, risk of bias, and adverse events were comparable between the intervention and placebo arms.
Conclusion: Based on treatment-seeking status, varenicline fails to show a significant difference between treatment-seeking and non-treatment seeking cohorts. Further, varenicline does not demonstrate a reduction over placebo in the chosen outcome of the PHDD in five of the eight reviewed trials. However, other measurable drinking behaviors such as cravings and overall alcohol consumption support a reduction in several studies regardless of treatment seeking status. Thus, varenicline therapy shows promise as a potential adjunctive therapy in those with AUD. However, the appropriate population and clinical situation to maximize varenicline benefit remain unclear. Therefore, further studies are indicated with more objective biomarkers to determine the drug’s actual effectiveness and targeted use.
Rice JF. Efficacy of Varenicline in Alcohol Use Disorder based on Treatment Seeking Status. Lynchburg Journal of Medical Science. 2021; 3(4).
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