Blodgett et al.,18 compared effect sizes for topiramate and naltrexone from 3 randomized trials (1 placebo-controlled and 2 open-label studies) that directly compared the two medications. Topiramate was associated with a significantly greater reduction than naltrexone on an aggregate measure of binge drinking (Hedges g=0.284, p=0.04), though not on an aggregate measure of abstinence (Hedges g=0.149, p=0.30). However, a recent meta-analysis comparing the effects of nalmefene, naltrexone, acamprosate, baclofen, and topiramate on reducing drinking in 6,036 patients,57 concluded that there was no high-grade evidence supporting the use of these medications to control drinking. Ascertaining the relative efficacy of medications to treat AUD will require large, high-quality RCTs that compare these and other medications directly.
