An open randomized trial comparing disulfiram and topiramate in the treatment of alcohol dependence

This study compared the efficacy of disulfiram (DSF) and topiramate (TPM) for preventing alcoholic relapse in an open study of routine clinical practice in India. One hundred alcohol-dependent men with family members who agreed to encourage medical compliance and to accompany them for follow-up were randomly allocated to 9 months of treatment with DSF or TPM. Weekly psychotherapy was also provided. There was no blinding of conditions for the psychiatrist, patient, or family members. Supervision and support of the family member were used in the maintenance of compliance among the patients. Alcohol consumption, craving, and adverse events were recorded weekly for 3 months and then biweekly. Serum gamma glutamyl transferase was measured at the start and at the end of the study. At the end of the trial, 92 patients were still in contact. Relapse occurred at a mean of 133 days for DSF as compared with 79 days for TPM. At 9 months, 90% of DSF patients, as compared with 56% of TPM patients, remained abstinent. TPM-treated patients did show less craving than DSF patients did. Further comparisons between these drugs in different treatment settings and patient populations are warranted.