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Questionable Efficacy for Naltrexone in Patients With Asp40
Jeffrey A. Mattes, MD
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The article by Anton et al1 is less positive than it may appear. They find evidence that patients with the Asp40 allele are more likely to respond to naltrexone hydrochloride treatment for alcoholism, but only if they received medical management (MM) alone, not if they also received combined behavioral intervention (CBI). They explain this by saying that CBI
may have compensated for the placebo effect, thereby suppressing the chances of observing a main effect of naltrexone or a genetic interaction.1(p140)
But does this make any sense? If CBI achieved such a good effect that a ceiling effect was evident, the statement might have some meaning. However, the graphs do not indicate any overall effect of CBI. Anton et al further state that CBI might have reduced "interindividual variability," which might have made it less likely for the "naltrexone and naltrexone x gene interaction to emerge."1(p140) However, . . . [Full Text of this Article]
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An Evaluation of µ-Opioid Receptor (OPRM1) as a Predictor of Naltrexone Response in the Treatment of Alcohol Dependence: Results From the Combined Pharmacotherapies and Behavioral Interventions for Alcohol Dependence (COMBINE) Study
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RELATED LETTER
Questionable Efficacy for Naltrexone in Patients With Asp40—Reply
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Arch Gen Psychiatry. 2009;66(7):796-797.
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