The first pill designed to curb a person’s urge to have more than a few drinks at a sitting is undergoing tests in Europe, promising doctors and public-health authorities a new approach to fighting alcoholism.
The drug, nalmefene from H. Lundbeck A/S in Valby, Denmark, blocks brain signals that make activities such as sex and drinking feel good. Should trials succeed, the medicine may win clearance in Europe as early as 2012, becoming the first new alcoholism treatment approved there in more than 15 years.
While the drugs now sold are used to prevent relapses after people quit drinking, nalmefene is aimed at reducing consumption without the abstinence that Alcoholics Anonymous and other treatment programs say is necessary. This less-strict approach may drive more abusers to seek treatment for the first time, said Adron Harris, director of the University of Texas at Austin’s Waggoner Center for Alcohol & Addiction Research.
“A major problem among alcohol abusers is that many are not interested in seeking treatment, perhaps because they do not want to accept the goal of complete abstinence,” Harris said.
The drug’s effects may prove greater on public health than on Lundbeck. Peter Welford, a London-based analyst at Jefferies International Ltd., said nalmefene may have peak sales for alcohol dependence of about $60 million a year, in 2018. That’s equivalent to a fraction of the $2.57 billion in total revenue for the company last year.
Welford’s estimate was held down by uncertainty over what price Lundbeck could demand and whether health-care providers would embrace a drug-based approach to treatment, he said.
“The market remains an untapped gold mine,” said Welford, who recommends buying Lundbeck shares.
Programs such as New York-based Alcoholics Anonymous, founded in 1935, require people to abstain. Choosing not to drink at all may be more effective than trying to curb consumption, according to a U.K. study published in March in Alcohol & Alcoholism, a journal of the London-based Medical Council on Alcohol. Drinkers who had sought treatment and abstained had fewer days of relapse when they imbibed too much, the researchers found.
“Many people make a decision to stop drinking,” said Peter McCann, a recovered alcoholic who is co-founder of Castle Craig Hospital, a rehabilitation clinic near Edinburgh. “They don’t need drugs to stop.”
It would be a great help to patients if nalmefene works, said Marvin Seppala, chief medical officer of Hazelden, the Center City, Minn., treatment center whose abstinence- based approach has been adopted in more than 40 countries. Seppala said he is cautious about prescribing medicines without abstinence, having worked with patients who tried to curb intake by taking naltrexone, a generic drug not developed for that purpose.
Naltrexone cuts the desire to drink by blocking the release of dopamine, a brain chemical that generates feelings of pleasure. The drug is approved as a treatment for people who have stopped drinking, and has been taken experimentally to reduce consumption without quitting alcohol. The medicine didn’t help the patients curb intake, Seppala said.
“They were unable to do anything that would be considered beneficial, going from a liter a day of distilled spirits to two drinks short of a liter,” Seppala said in an e-mail interview.
In September, the London-based European Medicines Agency, concerned that the all-or-nothing approach leaves millions untreated, included consumption-cutting medicines in its first guidelines to drugmakers on how to test experimental alcohol treatments. The London-based National Institute for Health & Clinical Excellence, or NICE, an adviser to the U.K.’s National Health Service, is considering new guidelines that recommend medication if other approaches fail.
There is a “critical need” for drugs to reduce drinking because alcoholism causes disability and contributes to suicide and accidents among young adults, said John Krystal, chairman of Yale University School of Medicine’s psychiatry department in New Haven, Connecticut, in an e-mail interview.
In the United States, fewer than one in 10 overusers of alcohol gets treatment, according to the National Institute on Alcohol Abuse and Alcoholism, or NIAAA, in Bethesda, Md. Nine of 10 Germans and 19 of 20 U.K. residents who abuse alcohol don’t get help, according to the Geneva-based World Health Organization.