Baclofen for alcohol use disorder-a systematic meta-analysis - Bschor, T.; Henssler, J.; Muller, M.; Baethge, C. (Acta Psychiatr Scand, 2018)
OBJECTIVE: To evaluate the efficacy and tolerability of baclofen vs. placebo for long-term treatment of alcohol use disorder. METHOD: Systematic review and meta-analysis following methods of the Cochrane Collaboration Handbook (PROSPERO registration: CRD42017073663). Primary outcome was the random-effects summary estimate of all standardized mean differences (SMDs), as calculated from the primary outcomes of each study. RESULTS: Fourteen double-blind RCTs (1522 patients) were included. Heterogeneity was substantial for most analyses (I(2) about 75%). Baclofen showed a small, but not statistically significant superiority over placebo: SMD = 0.22 ([95% CI: -0.03; 0.47], P = 0.09). This result was supported by a leave-one-out-analysis, and Orwin's fail-safe N, by predefined secondary analyses (on abstinence rates and amount of drinking), and by a post hoc-analysis of high-dose studies (>80 mg/day). An analysis of low risk of bias studies (SMD = 0.10 [-0.20; 0.41], P = 0.51, I(2) = 43.3%) found no effect. Exclusion of four studies focusing on patients with comorbidity yielded a small positive effect. Drop-out rates were similar. CONCLUSION: Our results question baclofen's utility in the long-term treatment of alcohol use disorder at both normal and high doses. While the confidence intervals indicate that marginally harmful or moderately beneficial effects of baclofen remain a possibility, the most likely effect size is slightly above placebo effects.
Keywords: journalArticle; Alcohol Drinking/*adverse effects/psychology; Alcoholism/*drug therapy/psychology; Baclofen/administration & dosage/*therapeutic use; Double-Blind Method; Female; GABA-B Receptor Agonists/therapeutic use; Humans; Male; Outcome Assessment, Health Care; Placebos/administration & dosage; Randomized Controlled Trials as Topic; alcohol dependence; alcohol use disorder; baclofen; meta-analysis