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Read Original Story

Drug Shows Promise in Curbing Compulsive Gambling, Study Says

Rating

2 Star

Drug Shows Promise in Curbing Compulsive Gambling, Study Says

Our Review Summary

This story discusses nalmefene, an opioid antagonist, which is a drug that affects the brain’s dopamine system and is thought to reduce the pleasurable sensation associated with addictive behaviors such as compulsive gambling. The drug was FDA approved for the treatment of alcoholism in 1994, but it is still under study for the treatment of other addictions. Nalmefene was tested in a multi-site, randomized, double-blind trial; however, there were only 207 participants, and of these, only 73 actually completed the full 16-week trial. There was no mention of this in the news story, and only brief discussion that a third of the participants dropped out due to nausea and “other side effects”. Other side effects included insomnia and dizziness and were slightly greater in those given a higher dose of nalmefene. Though the study was well-designed, results would not likely be generalizable to a larger population based solely on this small group of compulsive gamblers treated with nalmefene. No quantitative data is provided on the efficacy of the drug, and no information is provided on potential long-term side effects, namely the long-term side effects of this class of drug on the liver. Other opioid antagonist drugs such as naltrexone have shown some toxicity to the liver. Nalmefene does not appear to have the same incidence of toxicity, but long-term safety has not been studied. If this is a pill taken daily, as might be expected in patients with a chronic condition, more long-term data on liver and other toxicities is needed. No information is provided on the cost of the drug. Lastly, the journalist cites the primary author of the study, noting he has “no financial stake in BioTie”, maker of nalmefene, however, two other researchers are employees of BioTie Therapies, and in the disclosure section of the journal article there is a note that the study was supported by BioTie Therapies Corp.

Criteria

Does the story adequately discuss the costs of the intervention?

Not Satisfactory

No mention of

the cost of treatment.

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Not Satisfactory

This study was only 16 weeks and since compulsive

gambling, like other addictions, is a chronic disease, long-term data would be needed to prove efficacy and safely of this

medication. The story provided no absolute quantitative data on safety of efficacy or relative risk reduction in those who

took nalmefene. What’s the number needed to treat (NNT) in order to see a benefit? Additionally, results were slightly

better in higher dose of the drug, but these people experienced more intolerable side effects and were less likely to remain

in the study.

Does the story adequately explain/quantify the harms of the intervention?

Satisfactory

Mentions side effects such as nausea so bad that 1/3 of participants dropped out of the study. Insomnia and

dizziness were also common in the groups which took nalmefene. Not discussed was the potential long-term side effects of

this class of drug, namely the effect on the liver. The trial was only 16 weeks. Other opioid antagonist drugs such as

naltrexone have shown abnormalities in liver tests. Nalmefene does not appear to have the same incidence of toxicity, but

long-term safety has not been studied. If this is a pill taken daily, more long term data on liver toxicity is needed.

Does the story seem to grasp the quality of the evidence?

Not Satisfactory

Does not mention that this was a multi-site, double-blind,

randomized controlled study. Study included 207 people initially, but only 24 people in the placebo group and 49 in the

nalmefene group completed the 16-week trial. Though the study was well-designed, results would not likely be generalizable to

a larger population based on this small group of compulsive gamblers.

Does the story commit disease-mongering?

Satisfactory

Story includes a caveat that this is

“not a magic pill”. Gives U.S. incidence of compulsive gambling.

Does the story use independent sources and identify conflicts of interest?

Not Satisfactory

Cites primary author of the study, noting he has “no financial stake in BioTie”, maker of nalmefene. However, 2

other authors are employees of BioTie and in the disclosure section of the journal article there is a note the study was

supported by BioTie. The story didn’t mention this.

Does the story compare the new approach with existing alternatives?

Not Satisfactory

Mentions other biomedical research for

addictions such as gambling and the need for combined pharmacology and behavioral interventions, such as therapy. No real

comparison with other agents/studies in terms of treatment efficacy or safety profile.

Does the story establish the availability of the treatment/test/product/procedure?

Not Satisfactory

Not mentioned. Approved by FDA in 27 for treatment of alcoholism. Investigational drug not

currently approved for treatment of other addictions, such as gambling.

Does the story establish the true novelty of the approach?

Satisfactory

Mentions novelty of

treatment for gambling addiction. Not novel for other addictions. The ability of opiate antagonists to block compulsive

behaviors has been well described previously. See (Opioid antagonists in the treatment of impulse-control disorders.
J Clin

Psychiatry. 191 Apr;59(4):159-64. )

Total Score: 3 of 9 Satisfactory

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