Abstract

Cochrane systematic review couldn't find evidence of the effectiveness of baclofen in alcohol dependence for abstinence syndrome.

Background

According to Ukraine statistics incidence of chronic alcohol syndrome (alcoholism) as of 2010 was 1308.27 per 100 thousand. In absolute numbers it is 598,962 people 1. The problem is extremely urgent for our country.

Clinical guidelines mainly as first-line therapy for disorders related to alcohol, including alcohol dependence, recommend to use psychological intervention. Thus, National Institute for Health and Care Excellence (UK) recommends to use motivational interview, cognitive-behavioral and family therapy 2.

However, in alcohol dependence, after cessation / reduction of alcohol consumption, the patient faces the withdrawal syndrome - severe distress and potentially dangerous condition. Its manifestations include tremor, insomnia, anxiety, nightmares, paroxysmal sweating, tachycardia, agitation, hallucinations and more. In severe cases seizures and coma may develop.

Baclofen - is a receptor agonist of GABA-B, which is often used to alleviate this condition. According to the results of the preclinical studies the drug quickly reduces withdrawal symptoms in alcohol dependence, in addition there is evidence for its effect on delirium 3.

Results of the study

New analysis for the evaluation of baclofen effectiveness was conducted by Jia Liu and Lu-Ning Wang as part of Cochrane systematic review.

Using bibliographic databases authors reviewed all scientific works on this topic. Only 3 randomized controlled studies with a total sample of 141 patients were of sufficient quality to be included in the analysis. The data from these studies were insufficient for meta-analysis for the comparison with placebo.

In 2 trials were compared the efficacy of baclofen with another active treatment - diazepam and chlordiazepoxide. Scientists were able to analyze only the results of comparison with the last medication.

Based on this study baclofen has similar efficacy of chlordiazepoxide. But while baclofen was associated with 333 cases of side effects per 1000 patient, chlordiazepoxide - only with 133 per 1000. That is the first drug in 2.5 times more likely to cause adverse effects.

But still, the quality of the evidence was very low and scientists recommend not rely on them.

According to authors`, evidences on the efficacy or safety of baclofen are not enough for any conclusions. To determine the efficiency it is necessary to conduct further researches.

References

  1. Tabachnikov SI, Kharchenko EM, Marcenkovskaya II, Synitska TV. Comparative characteristic medical sociological aspects of alcohol addiction among teenagers and young persons in Ukraine. Archiv Psychiatrii. 2011; 2(65):77-81.
  2. National Institute for Health and Care Excellence. Alcohol-use disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence. London: NICE; 2011. Publisher Full Text
  3. Addolorato G, Leggio L, Abenavoli L, DeLorenzi G, Parente A, Caputo F, Janiri L, Capristo E, Rapaccini GL, Gasbarrini G. Suppression of alcohol delirium tremens by baclofen administration: a case report. Clin Neuropharmacol. 2003; 26(5):258-262. Publisher Full Text | PubMed
  4. Liu J, Wang LN. Baclofen for alcohol withdrawal. Cochrane Database of Systematic Reviews. 2017; 8:CD00852. DOI