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Letters to the Editor |

Questionable Efficacy for Naltrexone in Patients With Asp40

Jeffrey A. Mattes, MD
Arch Gen Psychiatry. 2009;66(7):796-797. doi:10.1001/archgenpsychiatry.2009.68.
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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

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 × gene interaction to emerge.”1(p140) However, no evidence is presented indicating that the group that received CBI had a smaller variance (though the main results of this study were apparently presented elsewhere).


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