TY - JOUR
T1 - Efficacy, tolerability, and safety of low-dose and high-dose baclofen in the treatment of alcohol dependence: A systematic review and meta-analysis
AU - Pierce, Mimi
AU - Sutterland, Arjen
AU - Beraha, Esther M.
AU - Morley, Kirsten
AU - van den Brink, Wim
PY - 2018
Y1 - 2018
N2 - A systematic review of the current literature on the efficacy of baclofen, particularly the effect of dosing, for the treatment of alcohol dependence (AD) is missing. We therefore conducted a systematic review and meta-analysis of currently available randomized placebo-controlled trials (RCTs). A systematic literature search for RCTs in AD patients comparing baclofen to placebo was performed in September 2017. The effect of baclofen treatment, and the moderating effects of baclofen dosing (low-dose (LDB) 30–60 mg versus high-dose (HDB) targeted as >60 mg/day), and the amount of alcohol consumption before inclusion were studied. Three treatment outcomes were assessed: time to lapse (TTL), percentage days abstinent (PDA), and percentage of patients abstinent at end point (PAE). 13 RCTs from 39 records were included. Baclofen was superior to placebo with significant increases in TTL (8 RCTs, 852 patients; SMD=0.42; 95% CI 0.19–0.64) and PAE (8 RCTs, 1244 patients; OR=1.93; 95% CI 1.17–3.17), and a non-significant increase in PDA (7 RCTs, 457 patients; SMD=0.21; 95% CI −0.24 to 0.66). Overall, studies with LDB showed better efficacy than studies with HDB. Furthermore, tolerability of HDB was low, but serious adverse events were rare. Meta-regression analysis showed that the effects of baclofen were stronger when daily alcohol consumption before inclusion was higher. Baclofen seems to be effective in the treatment of AD, especially among heavy drinkers. HDB is not necessarily more effective than LDB with low tolerability of HDB being an import limitation.
AB - A systematic review of the current literature on the efficacy of baclofen, particularly the effect of dosing, for the treatment of alcohol dependence (AD) is missing. We therefore conducted a systematic review and meta-analysis of currently available randomized placebo-controlled trials (RCTs). A systematic literature search for RCTs in AD patients comparing baclofen to placebo was performed in September 2017. The effect of baclofen treatment, and the moderating effects of baclofen dosing (low-dose (LDB) 30–60 mg versus high-dose (HDB) targeted as >60 mg/day), and the amount of alcohol consumption before inclusion were studied. Three treatment outcomes were assessed: time to lapse (TTL), percentage days abstinent (PDA), and percentage of patients abstinent at end point (PAE). 13 RCTs from 39 records were included. Baclofen was superior to placebo with significant increases in TTL (8 RCTs, 852 patients; SMD=0.42; 95% CI 0.19–0.64) and PAE (8 RCTs, 1244 patients; OR=1.93; 95% CI 1.17–3.17), and a non-significant increase in PDA (7 RCTs, 457 patients; SMD=0.21; 95% CI −0.24 to 0.66). Overall, studies with LDB showed better efficacy than studies with HDB. Furthermore, tolerability of HDB was low, but serious adverse events were rare. Meta-regression analysis showed that the effects of baclofen were stronger when daily alcohol consumption before inclusion was higher. Baclofen seems to be effective in the treatment of AD, especially among heavy drinkers. HDB is not necessarily more effective than LDB with low tolerability of HDB being an import limitation.
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85048828876&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/29934090
U2 - https://doi.org/10.1016/j.euroneuro.2018.03.017
DO - https://doi.org/10.1016/j.euroneuro.2018.03.017
M3 - Review article
C2 - 29934090
SN - 0924-977X
VL - 28
SP - 795
EP - 806
JO - European neuropsychopharmacology
JF - European neuropsychopharmacology
IS - 7
ER -