Systematic review: Baclofen dosing protocols for alcohol use disorders used in observational studies (European Neuropsychopharmacology, 2018)
Autoren: Andrew Thompson, Lynn Owens, Paul Richardson & Munir Pirmohamed
(pp, 05.08.2018)
MIT Reaktion von Marie Costa, Benjamin Rolland & P. Carrieri auf dieses Review
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Abstract im englischen Original
The popularity of baclofen as an anti-craving agent in the treatment of alcohol use disorders (AUDs) has increased, especially in patients with established liver disease. However, evidence-based guidelines to inform practice are lacking. The aim of this systematic review is explore the prescribing practices of baclofen in AUD treatment. Electronic databases were searched for relevant articles from 2002. Assessment of eligibility criteria for inclusion was performed independently by two investigators. The main outcomes of interest were maximum dose, starting dose, titration regimen, effectiveness, and tolerability. Twenty-five studies reporting outcomes in 613 patients treated with baclofen for an AUD were identified. Starting doses ranged between 5 and 50mg/d. Titration was study-dependent, and doses were increased until either therapeutic target (abstinence or study-defined low risk drinking) was achieved or adverse events resulted in a dose reduction or discontinuation. The maximum dose for individual patients ranged between 20 and 630mg/d. Seven studies reported at least one patient using >300mg/d. In studies with 10 or more patients, we found a negative correlation between dose and proportion of patients achieving the therapeutic goal. However, this was skewed by one study. A range of serious adverse events were reported. Most were reported at doses over 100mg/d, but others presented at lower doses. Baclofen is a promising therapeutic in this area. Evidence is required, however, to support practitioners in prescribing doses that optimise outcomes and reduce adverse events.
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Auf dieses Review vom November 2017 folgte im Mai 2018 eine Reaktion:
The need for patient-tailored dosing of baclofen in future clinical trials (European Neuropsychopharmacology, 2018)
Autoren: Marie Costa, Benjamin Rolland & P. Carrieri
Unter anderem heißt es darin:
The disappointing findings of recent randomized clinical trials should not nullify the prospects of baclofen as a possible treatment forAUD, as these findings could be the result of an inappropriate dosing strategy, and not necessarily the effect of the drug. Additional trials are therefore warranted, not only to better assess the effectiveness of patient-tailored dosing, but also to enable the identification of factors associated with response to baclofen.
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