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Article

Weak evidence on nalmefene creates dilemmas for clinicians and poses questions for regulators and researchers

Citation
Fitzgerald N, Angus K, Elders A, de Andrade M, Raistrick D, Heather N & McCambridge J (2016) Weak evidence on nalmefene creates dilemmas for clinicians and poses questions for regulators and researchers. Addiction, 111 (8), pp. 1477-1487. https://doi.org/10.1111/add.13438

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 ofa priorioutcome measures and sensitivity analyses, use ofpost-hocsample 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.

Keywords
Addiction; alcohol; brief intervention; nalmefene; trial regulation; vested interests

Journal
Addiction: Volume 111, Issue 8

StatusPublished
Author(s)Fitzgerald, Niamh; Angus, Kathryn; Elders, Andrew; de Andrade, Marisa; Raistrick, Duncan; Heather, Nick; McCambridge, Jim
FundersMedical Research Council
Publication date31/08/2016
Publication date online05/06/2016
Date accepted by journal21/04/2016
URLhttp://hdl.handle.net/1893/23289
PublisherWiley-Blackwell on behalf of Society for the Study of Addiction
ISSN0965-2140

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