Naltrexone and acamprosate are drugs that are supposed to suppress the desire for a drink. The researcher investigated which patient characteristics were responsible for predicting the drug that would work best.
Alcoholics have an overwhelming urge to drink. That desire not only facilitates alcohol addiction but also ensures that the habit is difficult to kick. There are two drugs that can suppress this longing for alcohol: naltrexone works via the reward system in the brain and acamprosate via the stress system. However, they do not work for everybody. The question was whether patient characteristics can predict which drug works best for which patient.
One hundred and fifty-six alcoholics were willing to participate in Ootemans' study. The participants’ desire to drink was aroused by, for example, placing a glass of their favourite drink on the table. Meanwhile they were posed questions about their urge for a drink and their physical reactions were measured, such as heart rate and sweat production. Genetic characteristics were also determined. After a month of treatment with naltrexone, acamprosate or a placebo the effect of clinical, physiological or genetic differences on the success of the treatment was examined.
Clinical patient characteristics were found to be a poor predictor of whether someone would respond best to acamprosate or naltrexone. Biological and genetic characteristics could, however, predict this. People who started to sweat profusely during the experiment, responded better to acamprosate, whereas people who sweated less profusely responded better to naltrexone. Further genes which code for certain receptors in the brain predicted which drug would be successful for a patient. In particular, the genes that code for the mu-opioid receptor, the dopamine D2 receptor and a gaba receptor were found to be good predictors. This might be because these genes are closely associated with the causes of addiction.
The question is whether these same results will be found if longer term relapse is examined. It is expected that in particular the highly-promising genetic characteristics will be used for a more effective allocation of alcoholics to different treatments.
Kim van den Wijngaard | alfa
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