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Aubin HJ. Repurposing drugs for treatment of alcohol use disorder. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2024; 175:153-185. [PMID: 38555115 DOI: 10.1016/bs.irn.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
Repurposing drugs for the treatment of alcohol dependence involves the use of drugs that were initially developed for other conditions, but have shown promise in reducing alcohol use or preventing relapse. This approach can offer a more cost-effective and time-efficient alternative to developing new drugs from scratch. Currently approved medications for alcohol use disorder (AUD) include acamprosate, disulfiram, naltrexone, nalmefene, baclofen, and sodium oxybate. Acamprosate was developed specifically for AUD, while disulfiram's alcohol-deterrent effects were discovered incidentally. Naltrexone and nalmefene were originally approved for opioids but found secondary applications in AUD. Baclofen and sodium oxybate were repurposed from neurological conditions. Other drugs show promise. Topiramate and zonisamide, anticonvulsants, demonstrate efficacy in reducing alcohol consumption. Another anticonvulsant, gabapentin has been disappointing overall, except in cases involving alcohol withdrawal symptoms. Varenicline, a nicotinic receptor agonist, benefits individuals with less severe AUD or concurrent nicotine use. Ondansetron, a 5-HT3 antagonist, has potential for early-onset AUD, especially when combined with naltrexone. Antipsychotic drugs like aripiprazole and quetiapine have limited efficacy. Further investigation is needed for potential repurposing of α1 adrenergic receptor antagonists prazosin and doxazosin, glucocorticoid receptor antagonist mifepristone, the phosphodiesterase inhibitor Ibudilast, the cysteine prodrug N-acetylcysteine, and the OX1R and OX2R blocker Suvorexant. This review supports repurposing drugs as an effective strategy for expanding treatment options for AUD.
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Affiliation(s)
- Henri-Jean Aubin
- Université Paris-Saclay, Inserm, CESP, Villejuif, France; AP-HP, Université Paris Saclay, Villejuif, France.
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Jeanblanc J, Sauton P, Houdant C, Fernandez Rodriguez S, de Sousa SV, Jeanblanc V, Bodeau S, Labat L, Soichot M, Vorspan F, Naassila M. Sex-related differences in the efficacy of Baclofen enantiomers on self-administered alcohol in a binge drinking pattern and dopamine release in the core of the nucleus accumbens. Front Pharmacol 2023; 14:1146848. [PMID: 37007041 PMCID: PMC10060511 DOI: 10.3389/fphar.2023.1146848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 03/07/2023] [Indexed: 03/18/2023] Open
Abstract
Introduction: Clinical studies on the effectiveness of Baclofen in alcohol use disorder (AUD) yielded mixed results possibly because of differential effects of the enantiomers and sex-related differences. Here we examined the effect of the different Baclofen enantiomers on alcohol intake and on evoked dopamine release in the core of the nucleus accumbens (NAcc) in male and female Long Evans rats.Methods: Rats were trained to chronically self-administer 20% alcohol solution in daily binge drinking sessions and were treated with the different forms of Baclofen [RS(±), R(+) and S(−)]. The effects on the evoked dopamine release within the core of the nucleus accumbens were measured in brain slices from the same animals and the alcohol naïve animals using the fast scan cyclic voltammetry technique.Results: RS(±)-Baclofen reduced alcohol intake regardless of sex but more females were non-responders to the treatment. R(+)-Baclofen also reduced alcohol intake regardless of sex but females were less sensitive than males. S(−)-Baclofen did not have any effect on average but in some individuals, especially in the females, it did increase alcohol intake by at least 100%. There were no sex differences in Baclofen pharmacokinetic but a strong negative correlation was found in females with a paradoxical effect of increased alcohol intake with higher blood Baclofen concentration. Chronic alcohol intake reduced the sensitivity to the effect of Baclofen on evoked dopamine release and S(−)-Baclofen increased dopamine release specifically in females.Discussion: Our results demonstrate a sex-dependent effect of the different forms of Baclofen with no or negative effects (meaning an increase in alcohol self-administration) in subgroup of females that could be linked to a differential effect on dopamine release and should warrant future clinical studies on alcohol use disorder pharmacotherapy that will deeply analyze sex difference.
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Affiliation(s)
- Jérôme Jeanblanc
- INSERM UMR-S 1247, Research Group on Alcohol and Pharmacodependences (GRAP), Université de Picardie Jules Verne, Amiens, France
- GDR3557 Psychiatrie-Addictions, Institut de Psychiatrie, University Hospital Federation (FHU A2M2P), Caen, France
| | - Pierre Sauton
- INSERM UMR-S 1247, Research Group on Alcohol and Pharmacodependences (GRAP), Université de Picardie Jules Verne, Amiens, France
- GDR3557 Psychiatrie-Addictions, Institut de Psychiatrie, University Hospital Federation (FHU A2M2P), Caen, France
| | - Charles Houdant
- INSERM UMR-S 1247, Research Group on Alcohol and Pharmacodependences (GRAP), Université de Picardie Jules Verne, Amiens, France
- GDR3557 Psychiatrie-Addictions, Institut de Psychiatrie, University Hospital Federation (FHU A2M2P), Caen, France
| | - Sandra Fernandez Rodriguez
- INSERM UMR-S 1247, Research Group on Alcohol and Pharmacodependences (GRAP), Université de Picardie Jules Verne, Amiens, France
| | - Sofia Vilelas de Sousa
- INSERM UMR-S 1247, Research Group on Alcohol and Pharmacodependences (GRAP), Université de Picardie Jules Verne, Amiens, France
| | - Virginie Jeanblanc
- Animal Facility of the Université de Picardie Jules Verne, Amiens, France
| | - Sandra Bodeau
- MP3CV Laboratory, Department of Clinical Pharmacology, Amiens University Hospital, University of Picardie Jules Verne, Amiens, France
| | - Laurence Labat
- INSERM UMR-S 1144, Optimisation Thérapeutique en Neuropsychopharmacologie, Université de Paris, Paris, France
- Faculté de Médecine, Université de Paris Cité, Paris, France
- Département de Psychiatrie et de Médecine Addictologique, Hôpital Fernand Widal, Assistance Publique—Hôpitaux de Paris, Paris, France
| | - Marion Soichot
- Laboratoire de Toxicologie Biologique, Hôpital Lariboisière, Paris, France
| | - Florence Vorspan
- INSERM UMRS1144, Département de Psychiatrie et de Médecine Addictologique, Assistance Publique—Hôpitaux de Paris, GH Lariboisière—Fernand Widal, GHU NORD, Université de Paris, Paris, France
| | - Mickael Naassila
- INSERM UMR-S 1247, Research Group on Alcohol and Pharmacodependences (GRAP), Université de Picardie Jules Verne, Amiens, France
- GDR3557 Psychiatrie-Addictions, Institut de Psychiatrie, University Hospital Federation (FHU A2M2P), Caen, France
- *Correspondence: Mickael Naassila,
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Recommendations from the EXTRIP workgroup on extracorporeal treatment for baclofen poisoning. Kidney Int 2021; 100:720-736. [PMID: 34358487 DOI: 10.1016/j.kint.2021.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 06/04/2021] [Accepted: 07/08/2021] [Indexed: 10/20/2022]
Abstract
Baclofen toxicity results from intentional self-poisoning ("acute baclofen poisoning") or accumulation of therapeutic dose in the setting of impaired kidney function. Standard care includes baclofen discontinuation, respiratory support and seizure treatment. Use of extracorporeal treatments (ECTRs) is controversial. To clarify this, a comprehensive review of the literature on the effect of ECTRs in baclofen toxicity was performed and recommendations following EXTRIP methods were formulated based on 43 studies. (1 comparative cohort, 1 aggregate results cohort, 1 pharmacokinetic modeling, and 40 patient reports or series). Toxicokinetic data were available for 20 patients. Baclofen's dialyzability is limited by a high endogenous clearance and a short half-life in patients with normal kidney function. The workgroup assessed baclofen as "Moderately dialyzable" by intermittent hemodialysis for patients with normal kidney function (quality of evidence C) and "Dialyzable" for patients with impaired kidney function (quality of evidence C). Clinical data were available for 25 patients with acute baclofen poisoning and 46 patients with toxicity from therapeutic baclofen in kidney impairment. No deaths or sequelae were reported. Mortality in historical controls was rare. No benefit of ECTR was identified in patients with acute baclofen poisoning. Indirect evidence suggests a benefit of ECTR in reducing the duration of toxic encephalopathy from therapeutic baclofen in kidney impairment. These potential benefits were balanced against added costs and harms related to the insertion of a catheter, the procedure itself, and the potential of baclofen withdrawal. Thus, the EXTRIP workgroup suggests against performing ECTR in addition to standard care for acute baclofen poisoning and suggests performing ECTR in toxicity from therapeutic baclofen in kidney impairment, especially in the presence of coma requiring mechanical ventilation.
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Echeverry‐Alzate V, Jeanblanc J, Sauton P, Bloch V, Labat L, Soichot M, Vorspan F, Naassila M. Is R(+)-Baclofen the best option for the future of Baclofen in alcohol dependence pharmacotherapy? Insights from the preclinical side. Addict Biol 2021; 26:e12892. [PMID: 32146727 DOI: 10.1111/adb.12892] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 02/14/2020] [Accepted: 02/18/2020] [Indexed: 12/16/2022]
Abstract
For several decades, studies conducted to evaluate the efficacy of RS(±)-Baclofen in the treatment of alcohol dependence yielded contrasting results. Human and animal studies recently questioned the use of the racemic drug in patients since a potential important role of the different enantiomers has been revealed with an efficacy thought to reside with the active R(+)-enantiomer. Here we conducted experiments in the postdependent rat model of alcohol dependence to compare the efficacy of R(+)-Baclofen or S(-)-Baclofen to that of RS(±)-Baclofen on ethanol intake, seeking, and relapse. R(+)-Baclofen was more effective than RS(±)-Baclofen in reducing ethanol intake and seeking during acute withdrawal and during relapse after abstinence. We also used an original population approach in order to identify drug responders. We found a significant proportion of responders to S(-)-Baclofen and RS(±)-Baclofen, displaying an increase in ethanol intake, and this increasing effect on alcohol intake was not seen in the R(+)-Baclofen group. At an intermediate dose of R(+)-Baclofen, devoid of any motor side effects, we identified a very large proportion of responders (75%) with a large decrease in ethanol intake (90% decrease). Finally, the response to RS(±)-Baclofen on ethanol intake was correlated to plasma level of Baclofen. R(+)-Baclofen and RS(±)-Baclofen were effective in reducing sucrose intake. Our study has important clinical implication since it suggests that the wide variability in the therapeutic responses of patients to RS(±)-Baclofen may come from the sensitivity to the R(+)-Baclofen but also to the one of the S(-)-Baclofen that can promote an increase in ethanol intake.
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Affiliation(s)
- Victor Echeverry‐Alzate
- INSERM UMR 1247‐Research Group on Alcohol and Pharmacodependences (GRAP) Université de Picardie Jules Verne Amiens France
- Instituto de Investigación Biomédica de Málaga (IBIMA) Hospital Regional Universitario de Málaga Spain
- Department of Psychobiology & Behavioral Sciences Methods, School of Psychology Complutense University of Madrid Spain
| | - Jérôme Jeanblanc
- INSERM UMR 1247‐Research Group on Alcohol and Pharmacodependences (GRAP) Université de Picardie Jules Verne Amiens France
| | - Pierre Sauton
- INSERM UMR 1247‐Research Group on Alcohol and Pharmacodependences (GRAP) Université de Picardie Jules Verne Amiens France
| | - Vanessa Bloch
- INSERM UMR‐S 1144 Université de Paris, Optimisation Thérapeutique en Neuropsychopharmacologie Paris France
- Faculté de Médecine Université de Paris Paris France
- Département de Psychiatrie et de Médecine Addictologique, Hôpital Fernand Widal Assistance Publique – Hôpitaux de Paris Paris France
| | - Laurence Labat
- INSERM UMR‐S 1144 Université de Paris, Optimisation Thérapeutique en Neuropsychopharmacologie Paris France
- Faculté de Médecine Université de Paris Paris France
- Département de Psychiatrie et de Médecine Addictologique, Hôpital Fernand Widal Assistance Publique – Hôpitaux de Paris Paris France
| | - Marion Soichot
- Laboratoire de Toxicologie Biologique – Hôpital Lariboisière Paris France
| | - Florence Vorspan
- INSERM UMR‐S 1144 Université de Paris, Optimisation Thérapeutique en Neuropsychopharmacologie Paris France
- Faculté de Médecine Université de Paris Paris France
- Département de Psychiatrie et de Médecine Addictologique, Hôpital Fernand Widal Assistance Publique – Hôpitaux de Paris Paris France
| | - Mickael Naassila
- INSERM UMR 1247‐Research Group on Alcohol and Pharmacodependences (GRAP) Université de Picardie Jules Verne Amiens France
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Affiliation(s)
- Michael C Reade
- Faculty of Medicine, University of Queensland, Brisbane, Australia
- Joint Health Command, Australian Defence Force, Canberra, Australia
- Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia
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Paino M, Aletraris L, Roman PM. The use of off-label medications in substance abuse treatment programs. Subst Abus 2019; 41:340-346. [PMID: 31361567 DOI: 10.1080/08897077.2019.1635962] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background: Substance use disorder (SUD) treatment centers serve a population of clients who have diverse needs, and may desire or require access to varied treatments while seeking care for their SUDs. While pharmacotherapies have increased in popularity for the treatment of SUDs, adoption rates do remain quite low. But a wider array of pharmacotherapies has become available in recent years which may shift the trend. This article helps shed light on how variations in SUD treatment centers develop and persist with regard to the adoption and delivery of off-label medications. Methods: We use a nationally representative and longitudinal sample of SUD treatment centers in the US (N = 196). We use a logistic regression to analyze the relationship between organizational characteristics and offering any medications, off-label. We also use a negative binomial regression to analyze the relationship between organizational characteristics and the number of medications that were used off-label. Results: Our findings reveal that older centers, accredited centers, and centers that offer mental health screenings are all positively associated with the provision of off-label medication in SUD treatment. We also find a positive relationship between private funding and offering a greater number of off-label medications. Conclusions: Our results suggest that SUD clients who seek treatment from centers that offer medications off-label, may have access to a greater number of medication-assisted treatment options.
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Affiliation(s)
- Maria Paino
- Department of Sociology, Anthropology, Social Work, and Criminal Justice, Oakland University, Rochester, Michigan, USA
| | - Lydia Aletraris
- Owens Institute for Behavioral Research, University of Georgia, Athens, Georgia, USA
| | - Paul M Roman
- Owens Institute for Behavioral Research, University of Georgia, Athens, Georgia, USA
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A capture-recapture method for estimating the incidence of off-label prescriptions: the example of baclofen for alcohol use disorder in France. Therapie 2019; 74:645-650. [PMID: 31277890 DOI: 10.1016/j.therap.2019.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 04/25/2019] [Accepted: 06/13/2019] [Indexed: 11/22/2022]
Abstract
The local/regional incidence of off-label prescriptions can be difficult to estimate. Capture-recapture models can be used to indirectly estimate population sizes. Here, we used a capture-recapture model to estimate the number of patients treated off-label with baclofen for alcohol use disorder in northern France in 2013. Three capture sources were used: (i) the active case file at the region's largest Addiction Unit, (ii) the regional pharmacovigilance centre, and (iii) a sample of community pharmacies. After between-source overlaps had been identified, we used a log-linear model to produced eight estimates. Two models displayed the best goodness-of-fit, with estimates [95% confidence interval] of 1123 [714-2162] and 2180 [1598-2870] subjects, respectively. These two values are in line with a previous estimate of 1624 patients, based on an analysis of the French national health insurance database in 2013. Capture-recapture methods can be usefully applied to estimate the prevalence of OLPs in a specific geographical area, when direct counting is not feasible or the estimate through claim database is not possible.
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Aubin HJ, Mann K. Medication Development: Reducing Casualties in the Valley of Death and Providing Support for Survivors. Alcohol Clin Exp Res 2019; 43:22-25. [DOI: 10.1111/acer.13909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 10/12/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Henri-Jean Aubin
- CESP; Faculté de médecine; University Paris-Sud, Faculté de médecine - UVSQ; INSERM; Université Paris- Saclay; AP-HP; Hôpitaux Universitaires Paris-Sud; Villejuif France
| | - Karl Mann
- Central Institute of Mental Health; Medical Faculty Mannheim; Heidelberg University; Mannheim Germany
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Narasimha VL, Menon T N J, Mahadevan J, Mukherjee D, Benegal V, Murthy P. Baclofen withdrawal hallucinosis. Asian J Psychiatr 2018; 36:90-91. [PMID: 30036734 DOI: 10.1016/j.ajp.2018.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 07/17/2018] [Indexed: 11/25/2022]
Affiliation(s)
- Venkata Lakshmi Narasimha
- Centre for Addiction Medicine, Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bengaluru, 560029, India.
| | - Jayakrishnan Menon T N
- Centre for Addiction Medicine, Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bengaluru, 560029, India
| | - Jayant Mahadevan
- Centre for Addiction Medicine, Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bengaluru, 560029, India
| | - Diptadhi Mukherjee
- Centre for Addiction Medicine, Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bengaluru, 560029, India
| | - Vivek Benegal
- Centre for Addiction Medicine, Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bengaluru, 560029, India
| | - Pratima Murthy
- Centre for Addiction Medicine, Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bengaluru, 560029, India
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Pierce M, Sutterland A, Beraha EM, Morley K, van den Brink W. Efficacy, tolerability, and safety of low-dose and high-dose baclofen in the treatment of alcohol dependence: A systematic review and meta-analysis. Eur Neuropsychopharmacol 2018; 28:795-806. [PMID: 29934090 DOI: 10.1016/j.euroneuro.2018.03.017] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Revised: 03/06/2018] [Accepted: 03/22/2018] [Indexed: 11/19/2022]
Abstract
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.
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Affiliation(s)
- Mimi Pierce
- Academic Medical Center University of Amsterdam, Amsterdam, The Netherlands
| | - Arjen Sutterland
- Department of Psychiatry, Academic Medical Center University of Amsterdam, Amsterdam, The Netherlands
| | - Esther M Beraha
- Addiction Development and Psychopathology (ADAPT) Lab, Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Kirsten Morley
- Discipline of Addiction Medicine, University of Sydney, NSW, Australia
| | - Wim van den Brink
- Department of Psychiatry, Academic Medical Center University of Amsterdam, Amsterdam, The Netherlands.
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Palpacuer C, Duprez R, Huneau A, Locher C, Boussageon R, Laviolle B, Naudet F. Pharmacologically controlled drinking in the treatment of alcohol dependence or alcohol use disorders: a systematic review with direct and network meta-analyses on nalmefene, naltrexone, acamprosate, baclofen and topiramate. Addiction 2018; 113:220-237. [PMID: 28940866 DOI: 10.1111/add.13974] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Revised: 05/16/2017] [Accepted: 07/28/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIMS Pharmacologically controlled drinking in the treatment of alcohol dependence or alcohol use disorders (AUDs) is an emerging concept. Our objective was to explore the comparative effectiveness of drugs used in this indication. DESIGN Systematic review with direct and network meta-analysis of double-blind randomized controlled trials (RCTs) assessing the efficacy of nalmefene, naltrexone, acamprosate, baclofen or topiramate in non-abstinent adults diagnosed with alcohol dependence or AUDs. Two independent reviewers selected published and unpublished studies on Medline, the Cochrane Library, Embase, ClinicalTrials.gov, contacted pharmaceutical companies, the European Medicines Agency and the Food and Drug Administration, and extracted data. SETTING Thirty-two RCTs. PARTICIPANTS A total of 6036 patients. MEASUREMENTS The primary outcome was total alcohol consumption (TAC). Other consumption outcomes and health outcomes were considered as secondary outcomes. FINDINGS No study provided direct comparisons between drugs. A risk of incomplete outcome data was identified in 26 studies (81%) and risk of selective outcome reporting in 17 (53%). Nalmefene [standardized mean difference (SMD) = -0.19, 95% confidence interval (CI) = -0.29, -0.10; I2 = 0%], baclofen (SMD = -1.00, 95% CI = -1.80, -0.19; one study) and topiramate (SMD = -0.77, 95% CI = -1.12, -0.42; I2 = 0%) showed superiority over placebo on TAC. No efficacy was observed for naltrexone or acamprosate. Similar results were observed for other consumption outcomes, except for baclofen (the favourable outcome on TAC was not reproduced). The number of withdrawals for safety reasons increased under nalmefene and naltrexone. No treatment demonstrated any harm reduction (no study was powered to explore health outcomes). Indirect comparisons suggested that topiramate was superior to nalmefene, naltrexone and acamprosate on consumption outcomes, but its safety profile is known to be poor. CONCLUSIONS There is currently no high-grade evidence for pharmacological treatment to control drinking using nalmefene, naltrexone, acamprosate, baclofen or topiramate in patients with alcohol dependence or alcohol use disorder. Some treatments show low to medium efficacy in reducing drinking across a range of studies with a high risk of bias. None demonstrates any benefit on health outcomes.
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Affiliation(s)
| | - Renan Duprez
- Fondation Saint Jean de Dieu, Centre Hospitalier Dinan/St Brieuc, Dinan, France
| | | | - Clara Locher
- Inserm, CIC 1414 Clinical Investigation Centre, Rennes, France.,Rennes University Hospital, Department of Biological and Clinical Pharmacology and Pharmacovigilance, Rennes, France.,Rennes 1 University, Laboratory of Experimental and Clinical Pharmacology, Rennes, France
| | - Rémy Boussageon
- Département de Médecine Générale, Faculté de Médecine et de Pharmacie, Université de Poitiers, Poitiers, France
| | - Bruno Laviolle
- Inserm, CIC 1414 Clinical Investigation Centre, Rennes, France.,Rennes University Hospital, Department of Biological and Clinical Pharmacology and Pharmacovigilance, Rennes, France.,Rennes 1 University, Laboratory of Experimental and Clinical Pharmacology, Rennes, France
| | - Florian Naudet
- Inserm, CIC 1414 Clinical Investigation Centre, Rennes, France.,Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Palo Alto, CA, USA
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Martinez L, Vorspan F, Declèves X, Azuar J, Fortias M, Questel F, Dereux A, Grichy L, Barreteau H, Bellivier F, Lépine JP, Bloch V. An observational study of benzodiazepine prescription during inpatient alcohol detoxification for patients with vs. without chronic pretreatment with high-dosage baclofen. Fundam Clin Pharmacol 2018; 32:200-205. [DOI: 10.1111/fcp.12339] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 11/13/2017] [Accepted: 12/05/2017] [Indexed: 12/18/2022]
Affiliation(s)
- Laura Martinez
- Groupe Hospitalier Saint-Louis- Lariboisière - Fernand Widal; Service de Pharmacie; Assistance Publique - Hôpitaux de Paris; 200 rue du Faubourg Saint Denis Paris 75010 France
| | - Florence Vorspan
- Département de Psychiatrie et de Médecine Addictologique; Groupe Hospitalier Saint-Louis- Lariboisière - Fernand Widal; Assistance Publique - Hôpitaux de Paris; 200 rue du Faubourg Saint Denis Paris 75010 France
- INSERM UMRS 1144 Variabilité de Réponse aux Psychotropes; PRES Sorbonne Paris Cité; Université Paris Descartes, Université Paris Diderot; 6 avenue de l'Observatoire Paris 75006 France
| | - Xavier Declèves
- INSERM UMRS 1144 Variabilité de Réponse aux Psychotropes; PRES Sorbonne Paris Cité; Université Paris Descartes, Université Paris Diderot; 6 avenue de l'Observatoire Paris 75006 France
| | - Julien Azuar
- Département de Psychiatrie et de Médecine Addictologique; Groupe Hospitalier Saint-Louis- Lariboisière - Fernand Widal; Assistance Publique - Hôpitaux de Paris; 200 rue du Faubourg Saint Denis Paris 75010 France
| | - Maeva Fortias
- Département de Psychiatrie et de Médecine Addictologique; Groupe Hospitalier Saint-Louis- Lariboisière - Fernand Widal; Assistance Publique - Hôpitaux de Paris; 200 rue du Faubourg Saint Denis Paris 75010 France
| | - Franck Questel
- Département de Psychiatrie et de Médecine Addictologique; Groupe Hospitalier Saint-Louis- Lariboisière - Fernand Widal; Assistance Publique - Hôpitaux de Paris; 200 rue du Faubourg Saint Denis Paris 75010 France
| | - Alexandra Dereux
- Département de Psychiatrie et de Médecine Addictologique; Groupe Hospitalier Saint-Louis- Lariboisière - Fernand Widal; Assistance Publique - Hôpitaux de Paris; 200 rue du Faubourg Saint Denis Paris 75010 France
| | - Leslie Grichy
- Département de Psychiatrie et de Médecine Addictologique; Groupe Hospitalier Saint-Louis- Lariboisière - Fernand Widal; Assistance Publique - Hôpitaux de Paris; 200 rue du Faubourg Saint Denis Paris 75010 France
| | - Hélène Barreteau
- Groupe Hospitalier Saint-Louis- Lariboisière - Fernand Widal; Service de Pharmacie; Assistance Publique - Hôpitaux de Paris; 200 rue du Faubourg Saint Denis Paris 75010 France
| | - Frank Bellivier
- Département de Psychiatrie et de Médecine Addictologique; Groupe Hospitalier Saint-Louis- Lariboisière - Fernand Widal; Assistance Publique - Hôpitaux de Paris; 200 rue du Faubourg Saint Denis Paris 75010 France
- INSERM UMRS 1144 Variabilité de Réponse aux Psychotropes; PRES Sorbonne Paris Cité; Université Paris Descartes, Université Paris Diderot; 6 avenue de l'Observatoire Paris 75006 France
| | - Jean-Pierre Lépine
- Département de Psychiatrie et de Médecine Addictologique; Groupe Hospitalier Saint-Louis- Lariboisière - Fernand Widal; Assistance Publique - Hôpitaux de Paris; 200 rue du Faubourg Saint Denis Paris 75010 France
- INSERM UMRS 1144 Variabilité de Réponse aux Psychotropes; PRES Sorbonne Paris Cité; Université Paris Descartes, Université Paris Diderot; 6 avenue de l'Observatoire Paris 75006 France
| | - Vanessa Bloch
- Groupe Hospitalier Saint-Louis- Lariboisière - Fernand Widal; Service de Pharmacie; Assistance Publique - Hôpitaux de Paris; 200 rue du Faubourg Saint Denis Paris 75010 France
- INSERM UMRS 1144 Variabilité de Réponse aux Psychotropes; PRES Sorbonne Paris Cité; Université Paris Descartes, Université Paris Diderot; 6 avenue de l'Observatoire Paris 75006 France
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13
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Durant CF, Paterson LM, Turton S, Wilson SJ, Myers JFM, Muthukumaraswamy S, Venkataraman A, Mick I, Paterson S, Jones T, Nahar LK, Cordero RE, Nutt DJ, Lingford-Hughes A. Using Baclofen to Explore GABA-B Receptor Function in Alcohol Dependence: Insights From Pharmacokinetic and Pharmacodynamic Measures. Front Psychiatry 2018; 9:664. [PMID: 30618857 PMCID: PMC6302106 DOI: 10.3389/fpsyt.2018.00664] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 11/19/2018] [Indexed: 12/20/2022] Open
Abstract
Background: The role of GABA-B neurotransmission in addiction has recently received increased attention, with clinical trials indicating that baclofen, a GABA-B receptor agonist, may reduce alcohol consumption, craving and promote abstinence. However, the optimal dose to treat alcohol dependence is unclear with patients requesting and tolerating much higher doses of baclofen, compared with other clinical uses. We assessed the pharmacokinetics and pharmacodynamics (PK/PD) of baclofen to provide insight into GABA-B sensitivity in this patient group, relative to controls. Methods: Male healthy volunteers (controls, n = 12) and abstinent alcohol dependent individuals (AD, n = 8) received single oral doses of baclofen or placebo in a 3-way crossover design. Controls received placebo/10 mg/60 mg baclofen in a randomized, double-blind design, AD received placebo/60 mg/90 mg baclofen in a single-blind design. PK/PD measures were recorded at baseline and multiple time-points up to 6 h post-dosing, including plasma baclofen, plasma growth hormone (GH), Subjective High Assessment Scale (SHAS) and biphasic alcohol effects scale (BAES). Repeated measures ANOVA analysis explored "change from baseline" dose, time, group, and interaction effects, t-tests compared peak effects. Results: Dose-dependent effects of baclofen on PK and PD measures were observed in both control and AD groups. Whilst there were no significant group differences in any baclofen PK parameters (t 1/2, t max , C max , AUC), marked differences in PD effects were clearly evident. In controls, 60 mg baclofen significantly increased total SHAS and BAES scores, and significantly increased plasma GH levels compared with placebo, with peak effects at 60-120 min, in line with its PK profile. In AD, 60 mg baclofen had limited effects on these parameters; SHAS scores, BAES scores and plasma GH levels were significantly blunted compared with controls (significant group*time interactions P = 0.0014, 0.0015 and P < 0.0001, respectively). Conclusions: Our study shows blunted sensitivity to baclofen in AD relative to controls, with no difference in PK suggesting a lower GABA-B receptor sensitivity. This may explain why higher baclofen doses are requested and tolerated in the treatment of alcohol dependence. Our data has implications for choice of dose in future clinical trials in AD and possibly other substances of dependence.
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Affiliation(s)
- Claire F Durant
- Neuropsychopharmacology Unit, Division of Brain Sciences, Department of Medicine, Centre for Psychiatry, Imperial College London, London, United Kingdom
| | - Louise M Paterson
- Neuropsychopharmacology Unit, Division of Brain Sciences, Department of Medicine, Centre for Psychiatry, Imperial College London, London, United Kingdom
| | - Sam Turton
- Neuropsychopharmacology Unit, Division of Brain Sciences, Department of Medicine, Centre for Psychiatry, Imperial College London, London, United Kingdom
| | - Susan J Wilson
- Neuropsychopharmacology Unit, Division of Brain Sciences, Department of Medicine, Centre for Psychiatry, Imperial College London, London, United Kingdom
| | - James F M Myers
- Neuropsychopharmacology Unit, Division of Brain Sciences, Department of Medicine, Centre for Psychiatry, Imperial College London, London, United Kingdom
| | | | - Ashwin Venkataraman
- Neuropsychopharmacology Unit, Division of Brain Sciences, Department of Medicine, Centre for Psychiatry, Imperial College London, London, United Kingdom
| | - Inge Mick
- Neuropsychopharmacology Unit, Division of Brain Sciences, Department of Medicine, Centre for Psychiatry, Imperial College London, London, United Kingdom
| | - Susan Paterson
- Centre for Brain Science, University of Auckland, Auckland, New Zealand
| | - Tessa Jones
- Neuropsychopharmacology Unit, Division of Brain Sciences, Department of Medicine, Centre for Psychiatry, Imperial College London, London, United Kingdom
| | - Limon K Nahar
- Centre for Brain Science, University of Auckland, Auckland, New Zealand
| | - Rosa E Cordero
- Centre for Brain Science, University of Auckland, Auckland, New Zealand
| | - David J Nutt
- Neuropsychopharmacology Unit, Division of Brain Sciences, Department of Medicine, Centre for Psychiatry, Imperial College London, London, United Kingdom
| | - Anne Lingford-Hughes
- Neuropsychopharmacology Unit, Division of Brain Sciences, Department of Medicine, Centre for Psychiatry, Imperial College London, London, United Kingdom
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14
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de Beaurepaire R, Sinclair JMA, Heydtmann M, Addolorato G, Aubin HJ, Beraha EM, Caputo F, Chick JD, de La Selle P, Franchitto N, Garbutt JC, Haber PS, Jaury P, Lingford-Hughes AR, Morley KC, Müller CA, Owens L, Pastor A, Paterson LM, Pélissier F, Rolland B, Stafford A, Thompson A, van den Brink W, Leggio L, Agabio R. The Use of Baclofen as a Treatment for Alcohol Use Disorder: A Clinical Practice Perspective. Front Psychiatry 2018; 9:708. [PMID: 30662411 PMCID: PMC6328471 DOI: 10.3389/fpsyt.2018.00708] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 12/03/2018] [Indexed: 12/12/2022] Open
Abstract
Alcohol use disorder (AUD) is a brain disorder associated with high rates of mortality and morbidity worldwide. Baclofen, a selective gamma-aminobutyric acid-B (GABA-B) receptor agonist, has emerged as a promising drug for AUD. The use of this drug remains controversial, in part due to uncertainty regarding dosing and efficacy, alongside concerns about safety. To date there have been 15 randomized controlled trials (RCTs) investigating the use of baclofen in AUD; three using doses over 100 mg/day. Two additional RCTs have been completed but have not yet been published. Most trials used fixed dosing of 30-80 mg/day. The other approach involved titration until the desired clinical effect was achieved, or unwanted effects emerged. The maintenance dose varies widely from 30 to more than 300 mg/day. Baclofen may be particularly advantageous in those with liver disease, due to its limited hepatic metabolism and safe profile in this population. Patients should be informed that the use of baclofen for AUD is as an "off-label" prescription, that no optimal fixed dose has been established, and that existing clinical evidence on efficacy is inconsistent. Baclofen therapy requires careful medical monitoring due to safety considerations, particularly at higher doses and in those with comorbid physical and/or psychiatric conditions. Baclofen is mostly used in some European countries and Australia, and in particular, for patients who have not benefitted from the currently used and approved medications for AUD.
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Affiliation(s)
| | - Julia M A Sinclair
- Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Mathis Heydtmann
- Department of Gastroenterology, Royal Alexandra Hospital Paisley, Paisley, United Kingdom
| | - Giovanni Addolorato
- AUD and Alcohol Related Diseases Unit, Department of Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario A Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy.,Department of Internal Medicine and Gastroenterology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Henri-Jean Aubin
- Faculté de Médecine, Centre de Recherche en Epidémiologie et Santé des Populations, Université Paris-Sud, Paris, France.,Faculté de Médecine, Université de Versailles Saint-Quentin-en-Yvelines, Paris, France.,Institut National de la Santé et de la Recherche Médicale, Université Paris-Saclay, Paris, France.,Hôpitaux Universitaires Paris-Sud, Paris, France
| | - Esther M Beraha
- Department of Psychology, University of Amsterdam, Amsterdam, Netherlands
| | - Fabio Caputo
- Department of Internal Medicine, SS. Annunziata Hospital, Cento, Italy
| | - Jonathan D Chick
- Castle Craig Hospital, Blyth Bridge, United Kingdom.,School of Health and Social Care, Edinburgh Napier University, Edinburgh, United Kingdom
| | | | - Nicolas Franchitto
- Department of Addiction Medicine, Poisons and Substance Abuse Treatment Centre, Toulouse-Purpan University Hospital, Toulouse, France
| | - James C Garbutt
- Department of Psychiatry, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Paul S Haber
- National Health Medical Research Council, Centre of Research Excellence in Mental Health and Substance Use, Central Clinical School, Sydney Medical School, University of Sydney, Sydney, NSW, Australia.,Drug Health Services, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Philippe Jaury
- Département de Médecine Générale, Faculté de Médecine, Université Paris Descartes, Paris, France
| | - Anne R Lingford-Hughes
- Neuropsychopharmacology Unit, Division of Brain Sciences, Centre for Psychiatry, Imperial College London, London, United Kingdom
| | - Kirsten C Morley
- Discipline of Addiction Medicine, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Christian A Müller
- Department of Psychiatry, Campus Charité Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Lynn Owens
- Wolfson Centre for Personalised Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Adam Pastor
- Department Addiction Medicine, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia.,Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - Louise M Paterson
- Neuropsychopharmacology Unit, Division of Brain Sciences, Centre for Psychiatry, Imperial College London, London, United Kingdom
| | - Fanny Pélissier
- Poison Control Center, Toulouse-Purpan University Hospital, Toulouse, France
| | - Benjamin Rolland
- Service Universitaire d'Addictologie de Lyon, Lyon, France.,University of Lyon, Lyon, France
| | | | - Andrew Thompson
- Wolfson Centre for Personalised Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Wim van den Brink
- Department of Psychiatry, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam University, Amsterdam, Netherlands
| | - Lorenzo Leggio
- Section on Clinical Psychoneuroendocrinology and Neuropsychopharmacology, Division of Intramural Clinical and Basic Research, National Institute on Alcohol Abuse and Alcoholism, National Institute on Drug Abuse Intramural Research Program, National Institutes of Health, Bethesda, MD, United States.,Medication Development Program, National Institute on Drug Abuse Intramural Research Program, National Institutes of Health, Baltimore, MD, United States.,Department of Behavioral and Social Sciences, Center for Alcohol and Addiction Studies, Brown University, Providence, RI, United States
| | - Roberta Agabio
- Section of Neuroscience and Clinical Pharmacology, Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
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15
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Auffret M, Rolland B, Caous AS, Gaboriau L, Deheul S, Bordet R, Gautier S. On-the-ground application of the ‘temporary recommendation for use’ regulatory measure on off-label use of baclofen for alcohol dependence in France: a regional survey of community pharmacies. Fundam Clin Pharmacol 2017; 32:234-238. [DOI: 10.1111/fcp.12332] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 10/02/2017] [Accepted: 11/09/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Marine Auffret
- Centre Régional de Pharmacovigilance; CHU de Lille; 1 place de Verdun F-59037 Lille Cedex France
| | - Benjamin Rolland
- Service d'Addictologie; Hôpital Fontan 2; CHU de Lille; F-59037 Lille France
- INSERM U1171; Université de Lille; 1 place de Verdun F-59045 Lille France
| | - Anne-Sylvie Caous
- Centre d'Evaluation et d'Information sur la Pharmacodépendance de Lille; CHU de Lille; 1 place de Verdun F-59037 Lille Cedex France
| | - Louise Gaboriau
- Centre Régional de Pharmacovigilance; CHU de Lille; 1 place de Verdun F-59037 Lille Cedex France
| | - Sylvie Deheul
- Centre d'Evaluation et d'Information sur la Pharmacodépendance de Lille; CHU de Lille; 1 place de Verdun F-59037 Lille Cedex France
| | - Régis Bordet
- Centre Régional de Pharmacovigilance; CHU de Lille; 1 place de Verdun F-59037 Lille Cedex France
- INSERM U1171; Université de Lille; 1 place de Verdun F-59045 Lille France
- Centre d'Evaluation et d'Information sur la Pharmacodépendance de Lille; CHU de Lille; 1 place de Verdun F-59037 Lille Cedex France
| | - Sophie Gautier
- Centre Régional de Pharmacovigilance; CHU de Lille; 1 place de Verdun F-59037 Lille Cedex France
- INSERM U1171; Université de Lille; 1 place de Verdun F-59045 Lille France
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16
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Thompson A, Owens L, Richardson P, Pirmohamed M. Systematic review: Baclofen dosing protocols for alcohol use disorders used in observational studies. Eur Neuropsychopharmacol 2017; 27:1077-1089. [PMID: 28939163 DOI: 10.1016/j.euroneuro.2017.08.434] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 08/10/2017] [Accepted: 08/30/2017] [Indexed: 01/15/2023]
Abstract
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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Affiliation(s)
- Andrew Thompson
- Wolfson Centre for Personalised Medicine, Institute of Translational Medicine, University of Liverpool, United Kingdom.
| | - Lynn Owens
- Wolfson Centre for Personalised Medicine, Institute of Translational Medicine, University of Liverpool, United Kingdom; Gastroenterology and Hepatology, Royal Liverpool University Hospital Trust, Ward 5z Link, Prescot Street, United Kingdom
| | - Paul Richardson
- Gastroenterology and Hepatology, Royal Liverpool University Hospital Trust, Ward 5z Link, Prescot Street, United Kingdom
| | - Munir Pirmohamed
- Wolfson Centre for Personalised Medicine, Institute of Translational Medicine, University of Liverpool, United Kingdom
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17
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Franchitto N, De Haro L, Pélissier F. Focusing solely on the effect of the medication without taking a holistic view of the patient does not seem very constructive. Clin Toxicol (Phila) 2017; 56:309. [PMID: 28874088 DOI: 10.1080/15563650.2017.1373781] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Nicolas Franchitto
- a Poison Control Center , Toulouse-Purpan University Hospital , Toulouse , France.,b Department of Addiction Medicine , Toulouse-Purpan University Hospital , Toulouse , France
| | - Luc De Haro
- c Poison Control Center, Clinical Pharmacology Department , Sainte Marguerite Hospital , Marseille , France
| | - Fanny Pélissier
- a Poison Control Center , Toulouse-Purpan University Hospital , Toulouse , France
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18
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Pelissier F, de Haro L, Rolland B, Franchitto N. Severity of Baclofen Self-Poisoning Linked to Psychiatric Co-morbidity in Alcohol-Dependent Patients: Better Measurement of Risk and Benefit. Basic Clin Pharmacol Toxicol 2017; 121:217-219. [PMID: 28693052 DOI: 10.1111/bcpt.12832] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Fanny Pelissier
- Poison Control Center, Toulouse-Purpan University Hospital, Toulouse, France
| | - Luc de Haro
- Poison Control Center, Clinical Pharmacology Department, Sainte Marguerite Hospital, Marseille, France
| | - Benjamin Rolland
- Department of Psychiatry and Addictology, Lille University Hospital, Lille, France
| | - Nicolas Franchitto
- Poison Control Center, Toulouse-Purpan University Hospital, Toulouse, France.,Department of Addiction Medicine, Toulouse-Purpan University Hospital, Toulouse, France
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19
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Pignon B, Labreuche J, Auffret M, Gautier S, Deheul S, Simioni N, Cottencin O, Bordet R, Duhamel A, Rolland B. The dose-effect relationship of baclofen in alcohol dependence: A 1-year cohort study. Hum Psychopharmacol 2017; 32. [PMID: 28517239 DOI: 10.1002/hup.2593] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 12/15/2016] [Accepted: 03/16/2017] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Our aim is to study the relationship between dose of baclofen and effectiveness in alcohol dependence. METHODS Two hundred two patients with alcohol dependence, who received baclofen treatment for drinking reduction, were followed up for 1 year. For each patient-month of treatment, the maximum daily dose of baclofen (DDB) and average weekly alcohol consumption (AWAC) were calculated. We defined a favorable drinking outcome as an AWAC under 200 g/w for at least 2 consecutive months. We divided the DDB of each patient-month into 3 categories (low dose: <90 mg/d, medium dose: 90-150 mg/d, and high dose: >150 mg/d) and investigated the relationship between reaching a favorable outcome and the concurrent DDB category in a time-varying Cox regression analysis. Hazard ratios (HRs) were adjusted based on age, sex, and initial AWAC. RESULTS One hundred forty subjects were followed during at least 1 month. Of these patients, 58 (41%) had a favorable drinking outcome. In comparison to low dose, medium dose was associated with a decreased rate of favorable drinking outcome (HR = 0.42; 95% CI [0.20, 0.88]), whereas no difference was found with high dose (HR = 1.31; 95% CI [0.65, 2.64]). CONCLUSION The relationship between dose of baclofen and favorable drinking outcome was U-shaped, that is, was increased at low and high doses compared to medium doses.
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Affiliation(s)
- Baptiste Pignon
- Psychiatry and Addiction Medicine Department, CHU Lille, Lille, France
| | - Julien Labreuche
- Department of Biostatistics, Univ. Lille, CHU Lille, EA 2694 - Santé publique : épidémiologie et qualité des soins, Lille, France
| | - Marine Auffret
- INSERM U1171, pharmacovigilance - addictovigilance, Univ. Lille, Lille, France
| | - Sophie Gautier
- INSERM U1171, pharmacovigilance - addictovigilance, Univ. Lille, Lille, France
| | - Sylvie Deheul
- INSERM U1171, pharmacovigilance - addictovigilance, Univ. Lille, Lille, France
| | - Nicolas Simioni
- Psychiatry and Addiction Medicine Department, CHU Lille, Lille, France
| | - Olivier Cottencin
- Psychiatry and Addiction Medicine Department, CHU Lille, Lille, France.,CNRS, UMR 9193, SCALab - PsyCHIC Team, Univ. Lille, Lille, France
| | - Régis Bordet
- INSERM U1171, pharmacovigilance - addictovigilance, Univ. Lille, Lille, France
| | - Alain Duhamel
- Department of Biostatistics, Univ. Lille, CHU Lille, EA 2694 - Santé publique : épidémiologie et qualité des soins, Lille, France.,CERIM, Univ. Lille, Lille, France
| | - Benjamin Rolland
- Psychiatry and Addiction Medicine Department, CHU Lille, Lille, France.,INSERM U1171, pharmacovigilance - addictovigilance, Univ. Lille, Lille, France
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20
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Reynaud M, Aubin HJ, Trinquet F, Zakine B, Dano C, Dematteis M, Trojak B, Paille F, Detilleux M. A Randomized, Placebo-Controlled Study of High-Dose Baclofen in Alcohol-Dependent Patients—The ALPADIR Study. Alcohol Alcohol 2017; 52:439-446. [DOI: 10.1093/alcalc/agx030] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 05/02/2017] [Indexed: 11/12/2022] Open
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21
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Synergistic antipruritic effects of gamma aminobutyric acid A and B agonists in a mouse model of atopic dermatitis. J Allergy Clin Immunol 2017; 140:454-464.e2. [PMID: 28232084 DOI: 10.1016/j.jaci.2017.02.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 01/25/2017] [Accepted: 02/01/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND Despite recent insights into the pathophysiology of acute and chronic itch, chronic itch remains an often intractable condition. Among major contributors to chronic itch is dysfunction of spinal cord gamma aminobutyric acidergic (GABAergic) inhibitory controls. OBJECTIVES We sought to test the hypothesis that selective GABA agonists as well as cell transplant-derived GABA are antipruritic against acute itch and in a transgenic mouse model of atopic dermatitis produced by overexpression of the TH2 cell-associated cytokine, IL-31 (IL-31Tg mice). METHODS We injected wild-type and IL-31Tg mice with combinations of GABA-A (muscimol) or GABA-B (baclofen) receptor agonists 15 to 20 minutes prior to injection of various pruritogens (histamine, chloroquine, or endothelin-1) and recorded spontaneous scratching before and after drug administration. We also tested the antipruritic properties of intraspinal transplantation of precursors of GABAergic interneurons in the IL-31Tg mice. RESULTS Systemic muscimol or baclofen are antipruritic against both histamine-dependent and -independent pruritogens, but the therapeutic window using either ligand alone was very small. In contrast, combined subthreshold doses of baclofen and muscimol produced a significant synergistic antipruritic effect, with no sedation. Finally, transplant-mediated long-term enhancement of GABAergic signaling not only reduced spontaneous scratching in the IL-31Tg mice but also dramatically resolved the associated skin lesions. CONCLUSIONS Although additional research is clearly needed, existing approved GABA agonists should be considered in the management of chronic itch, notably atopic dermatitis.
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22
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Pelissier F, de Haro L, Cardona F, Picot C, Puskarczyk E, Sapori JM, Tournoud C, Franchitto N. Self-poisoning with baclofen in alcohol-dependent patients: national reports to French Poison Control Centers, 2008–2013. Clin Toxicol (Phila) 2017; 55:275-284. [DOI: 10.1080/15563650.2017.1284330] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Fanny Pelissier
- Poison Control Center, Toulouse-Purpan University Hospital, Toulouse, France
| | - Luc de Haro
- Poison Control Center, Clinical Pharmacology Department, Sainte Marguerite Hospital, Marseille, France
- Groupe de Travail Toxicovigilance des Médicaments, ANSM, Saint Denis, France
- Comité de Coordination de Toxicovigilance, Institut de Veille Sanitaire (InVS), Saint Maurice, France
| | - Florence Cardona
- Groupe de Travail Toxicovigilance des Médicaments, ANSM, Saint Denis, France
- French National Agency for Medicines and Health Products Safety (ANSM), Saint Denis, France
| | - Cyndie Picot
- Groupe de Travail Toxicovigilance des Médicaments, ANSM, Saint Denis, France
- Comité de Coordination de Toxicovigilance, Institut de Veille Sanitaire (InVS), Saint Maurice, France
- French National Agency for Medicines and Health Products Safety (ANSM), Saint Denis, France
| | - Emmanuel Puskarczyk
- Comité de Coordination de Toxicovigilance, Institut de Veille Sanitaire (InVS), Saint Maurice, France
- Poison Information and Toxicovigilance Center, Nancy University Medical Center, Nancy, France
| | - Jean-Marc Sapori
- Comité de Coordination de Toxicovigilance, Institut de Veille Sanitaire (InVS), Saint Maurice, France
- Toxicovigilance and Poison Control Center, Hospices Civils de Lyon, Lyon, France
| | - Christine Tournoud
- Groupe de Travail Toxicovigilance des Médicaments, ANSM, Saint Denis, France
- Comité de Coordination de Toxicovigilance, Institut de Veille Sanitaire (InVS), Saint Maurice, France
- Poison Information and Toxicovigilance Center, Hôpital Civil, Strasbourg, France
| | - Nicolas Franchitto
- Poison Control Center, Toulouse-Purpan University Hospital, Toulouse, France
- Groupe de Travail Toxicovigilance des Médicaments, ANSM, Saint Denis, France
- Comité de Coordination de Toxicovigilance, Institut de Veille Sanitaire (InVS), Saint Maurice, France
- Department of Addiction Medicine, Toulouse-Purpan University Hospital, Toulouse, France
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Rolland B, Auffret M, Labreuche J, Lapeyre-Mestre M, Dib M, Kemkem A, Grit I, Drelon M, Duhamel A, Cabe N, Vabret F, Guillin O, Baguet A, Masquelier C, Dervaux A, Deheul S, Bordet R, Carton L, Cottencin O, Jardri R, Gautier S. Phone-based safety monitoring of the first year of baclofen treatment for alcohol use disorder: the BACLOPHONE cohort study protocol. Expert Opin Drug Saf 2016; 16:125-132. [PMID: 27984918 DOI: 10.1080/14740338.2017.1270939] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND In France, baclofen is frequently used off-label for alcohol use disorder (AUD). Baclofen has been associated with diverse adverse events (AEs), but the causality of these AEs has never been properly assessed. METHODS/DESIGN BACLOPHONE is a prospective multicenter cohort study conducted in the Hauts-de-France and Normandie French regions. BACLOPHONE consists of the phone-based monitoring of 792 patients during their first year of baclofen treatment for AUD. Two initial phone interviews assess the medical history, current medications, and substance use as well as complete the alcohol use identification test (AUDIT) and severity of alcohol dependence questionnaire (SADQ). Daily alcohol use and baclofen doses are noted throughout the follow-up. For every reported AE, additional phone interviews determine the seriousness of the AE, the causality of baclofen using validated causality algorithms, and the final outcome. The main objective of the study is to determine the rate of patients who stop baclofen due to an AE during the first year of treatment. DISCUSSION BACLOPHONE will provide important safety data on baclofen as a complement to the forthcoming efficacy data of randomized clinical trials.
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Affiliation(s)
- Benjamin Rolland
- a Département de Pharmacologie Médicale , INSERM U 1171, Univ Lille , Lille , France.,b Service d'Addictologie, CHU Lille , Lille , France
| | - Marine Auffret
- c Centre Régional de Pharmacovigilance, CHU Lille , Lille , France
| | - Julien Labreuche
- d Plateforme d'Aide Méthodologique , Biostatistique et Datamanagement, CHU Lille , Lille , France
| | - Maryse Lapeyre-Mestre
- e Service de Pharmacologie Clinique, CEIP-Addictovigilance, CIC 1436, CHU de ToulouseUMR-INSERM 1027 Universite Paul Sabatier - Toulouse 3 , Toulouse , France
| | - Malek Dib
- f Fédération de Recherche Clinique, CHU Lille , Lille , France
| | - Aomar Kemkem
- f Fédération de Recherche Clinique, CHU Lille , Lille , France
| | - Isabelle Grit
- f Fédération de Recherche Clinique, CHU Lille , Lille , France
| | - Marie Drelon
- g Centre d'Investigation Clinique, CHU Lille , Lille , France
| | - Alain Duhamel
- d Plateforme d'Aide Méthodologique , Biostatistique et Datamanagement, CHU Lille , Lille , France.,h CERIM, EA 2694, Univ Lille , Lille , France
| | - Nicolas Cabe
- i Service d'Addictologie, CHU de Caen , Caen , France
| | | | - Olivier Guillin
- k Centre Hospitalier du Rouvray, CHU de Rouen , Rouen , France
| | | | - Céline Masquelier
- p Centre Hospitalier Regional Universitaire de Lille Ringgold standard institution - Biostatistics CHU Lille , Lille , France
| | - Alain Dervaux
- l Service d'Addictologie, CHU d'Amiens , Amiens , France
| | - Sylvie Deheul
- m Centre d'Evaluation et d'Information sur les Pharmacodépendances, CHU Lille , Lille , France
| | - Régis Bordet
- a Département de Pharmacologie Médicale , INSERM U 1171, Univ Lille , Lille , France.,c Centre Régional de Pharmacovigilance, CHU Lille , Lille , France.,m Centre d'Evaluation et d'Information sur les Pharmacodépendances, CHU Lille , Lille , France
| | - Louise Carton
- a Département de Pharmacologie Médicale , INSERM U 1171, Univ Lille , Lille , France
| | - Olivier Cottencin
- b Service d'Addictologie, CHU Lille , Lille , France.,n SCALab UMR CNRS 9193, Univ Lille , Lille , France
| | - Renaud Jardri
- n SCALab UMR CNRS 9193, Univ Lille , Lille , France.,o Centre Universitaire de Recherche et d'Exploration, CHU Lille , Lille , France
| | - Sophie Gautier
- a Département de Pharmacologie Médicale , INSERM U 1171, Univ Lille , Lille , France.,c Centre Régional de Pharmacovigilance, CHU Lille , Lille , France
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Addolorato G, Mirijello A, Barrio P, Gual A. Treatment of alcohol use disorders in patients with alcoholic liver disease. J Hepatol 2016; 65:618-30. [PMID: 27155530 DOI: 10.1016/j.jhep.2016.04.029] [Citation(s) in RCA: 131] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 03/24/2016] [Accepted: 04/25/2016] [Indexed: 12/18/2022]
Abstract
Alcohol use disorders (AUDs) is one of the leading causes of disease and disability in almost all European countries. Among the alcohol-related diseases, alcoholic liver disease (ALD) is the most common. At present, alcohol is the most frequent cause of liver cirrhosis in the Western world. The cornerstone of treatment for ALD is achieving total alcohol abstinence and preventing relapse; medical and surgical treatments for ALD are limited when drinking continues. This narrative review summarizes current treatments for AUDs with a particular emphasis to the treatment of AUDs in patients with ALD. Medical management, psychosocial and pharmacological interventions are analyzed, underlying limits and options in AUD patients. Finally, this review discusses the most appropriate setting for the management of AUD patients with advanced liver disease as well as the indications for liver transplantation in AUD patients.
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Affiliation(s)
- Giovanni Addolorato
- Alcohol Use Disorders Unit, Department of Internal Medicine, Gastroenterology and Hepatology, Catholic University of Rome, Italy.
| | - Antonio Mirijello
- Alcohol Use Disorders Unit, Department of Internal Medicine, Gastroenterology and Hepatology, Catholic University of Rome, Italy; Department of Medical Sciences, IRCCS Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo, FG, Italy
| | - Pablo Barrio
- Department of Psychiatry, Neurosciences Institute, Hospital Clínic, IDIBAPS, Barcelona, Spain
| | - Antoni Gual
- Department of Psychiatry, Neurosciences Institute, Hospital Clínic, IDIBAPS, Barcelona, Spain.
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Geoffroy PA, Rolland B. Does baclofen have antidepressant qualities? Encephale 2016; 42:384-5. [PMID: 27216595 DOI: 10.1016/j.encep.2016.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 04/13/2015] [Indexed: 11/19/2022]
Affiliation(s)
- P A Geoffroy
- Inserm, UMR-S 1144, 75006 Paris, France; Service de psychiatrie adulte, pôle neurosciences, groupe hospitalier Saint-Louis-Lariboisière-Fernand Widal, AP-HP, 200, rue du Faubourg-Saint-Denis, 75475 Paris cedex 10, France; UMR-S 1144, université Paris Descartes, 75006 Paris, France; UMR-S 1144, université Paris Diderot, 75013 Paris, France; Fondation FondaMental, 94000 Créteil, France.
| | - B Rolland
- Inserm U 1171, université de Lille, 59045 Lille, France; Service d'addictologie, CHRU de Lille, 59037 Lille, France
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Richter E, Baldovini A, Blasco V, Leone M, Albanese J. About baclofen withdrawal syndrome. Presse Med 2016; 45:547-8. [DOI: 10.1016/j.lpm.2016.02.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 02/12/2016] [Accepted: 02/22/2016] [Indexed: 11/16/2022] Open
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Rolland B, Auffret M, Franchitto N. Safety reports on the off-label use of baclofen for alcohol-dependence: recommendations to improve causality assessment. Expert Opin Drug Saf 2016; 15:747-51. [DOI: 10.1517/14740338.2016.1168397] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Benjamin Rolland
- Service d’Addictologie, CHU Lille, Lille, France
- Département de Pharmacologie Médicale INSERM U,1171, Univ Lille, Lille, France
| | - Marine Auffret
- Centre Régional de Pharmacovigilance, INSERM U1171, CHU Lille, Lille, France
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Simioni N, Preda C, Deken V, Bence C, Cottencin O, Rolland B. Characteristics of Patients with Alcohol Dependence Seeking Baclofen Treatment in France: A Two-Centre Comparative Cohort Study. Alcohol Alcohol 2016; 51:664-669. [PMID: 26988996 DOI: 10.1093/alcalc/agw011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 02/17/2016] [Indexed: 11/13/2022] Open
Abstract
AIM To characterize the profile of patients seeking baclofen treatment for alcohol dependence in France. METHOD We compared retrospectively baclofen seekers and baclofen non-seekers within a cohort of consecutive outpatients with alcohol dependence who attended a first appointment for alcohol treatment at two French addiction centres between September 2012 and March 2014. We documented socio-demographic characteristics; comorbid psychiatric, addiction, alcohol dependence features; patients' initial drinking goal, and referral status; and treatment retention at 6 and 12 months. RESULTS Of the 289 patients identified, 107 were baclofen seekers and 182 were baclofen non-seekers. The only parameters significantly associated with baclofen seekers in multivariate analyses were a greater baseline alcohol consumption (β = 15.4, 95% CI: 0.18-30.65, P = 0.05), a controlled-drinking initial goal (OR = 14.9, 95% CI: 7.7-29, P < 0.0001) and self-referral (OR = 6.6, 95% CI: 3.7-12, P < 0.0001), baclofen seekers being eight times more likely to be self-referred and treatment-naïve (OR = 8.8, 95% CI: 4.1-18.9, P < 0.0001). Baclofen seekers were more likely to be retained in treatment at 6 months (OR = 3.5, 95% CI: 1.8-6.7, P < 0.0001) and 12 months (OR = 1.9, 95% CI: 1.1-3.2, P = 0.019). CONCLUSION In France, the perspective of controlled drinking offered by baclofen treatment may have attracted more self-referred patients, including those without previous alcohol treatment, to attend treatment, than the usual treatment options. These findings raise the question as to whether future public health strategies on alcohol should more prominently promote some aspects of alcohol treatment, such as patient's preference and treatment options, in order to reduce the treatment gap in alcohol dependence.
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Affiliation(s)
- Nicolas Simioni
- CHU Lille, Département de Psychiatrie et d'Addictologie, Lille, France Etablissement Public de Santé Mentale, Val de Lys - Artois, Centre de Soins d'Accompagnement et de Prévention en Addictologie, Béthune, France
| | - Cristian Preda
- Univ. Lille, CHU Lille, EA 2694 - Santé publique : épidémiologie et qualité des soins, Lille, France
| | - Valérie Deken
- Univ. Lille, CHU Lille, EA 2694 - Santé publique : épidémiologie et qualité des soins, Lille, France
| | - Camille Bence
- CHU Lille, Département de Psychiatrie et d'Addictologie, Lille, France
| | - Olivier Cottencin
- CHU Lille, Département de Psychiatrie et d'Addictologie, Lille, France Univ. Lille, CNRS UMR 9193, SCALab-PsyCHIC team, Lille, France
| | - Benjamin Rolland
- CHU Lille, Département de Psychiatrie et d'Addictologie, Lille, France Univ. Lille, INSERM U1171, Département de Pharmacologie, Lille, France
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Lorrai I, Maccioni P, Gessa GL, Colombo G. R(+)-Baclofen, but Not S(-)-Baclofen, Alters Alcohol Self-Administration in Alcohol-Preferring Rats. Front Psychiatry 2016; 7:68. [PMID: 27148096 PMCID: PMC4834306 DOI: 10.3389/fpsyt.2016.00068] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 04/04/2016] [Indexed: 01/14/2023] Open
Abstract
Racemic baclofen [(±)-baclofen] has repeatedly been reported to suppress several -alcohol-motivated behaviors, including alcohol drinking and alcohol -self-administration, in rats and mice. Recent data suggested that baclofen may have bidirectional, stereospecific effects, with the more active enantiomer, R(+)-baclofen, suppressing alcohol intake and the less active enantiomer, S(-)-baclofen, stimulating alcohol intake in mice. The present study was designed to investigate whether this enantioselectivity of baclofen effects may also extend to the reinforcing properties of alcohol in rats. To this end, selectively bred Sardinian alcohol-preferring (sP) rats were initially trained to lever respond on a fixed ratio 4 (FR4) schedule of reinforcement for alcohol (15%, v/v) in daily 30-min sessions. Once responding had stabilized, rats were tested with vehicle, (±)-baclofen (3 mg/kg), R(+)-baclofen (0.75, 1.5, and 3 mg/kg), and S(-)-baclofen (6, 12, and 24 mg/kg) under the FR4 schedule of reinforcement. Treatment with 3 mg/kg (±)-baclofen reduced the number of lever responses for alcohol and estimated amount of self-administered alcohol by approximately 60% in comparison to vehicle treatment. R(+)-baclofen was approximately twice as active as (±)-baclofen: treatment with 1.5 mg/kg R(+)-baclofen decreased both variables to an extent similar to that of the decreasing effect of 3 mg/kg (±)-baclofen. Conversely, treatment with all doses of S(-)-baclofen failed to affect alcohol self administration. These results (a) confirm that non-sedative doses of (±)-baclofen effectively suppressed the reinforcing properties of alcohol in sP rats and (b) apparently do not extend to operant alcohol self-administration in sP rats the capability of S(-)-baclofen to stimulate alcohol drinking in mice.
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Affiliation(s)
- Irene Lorrai
- Neuroscience Institute, National Research Council of Italy - Cagliari Section , Monserrato , Italy
| | - Paola Maccioni
- Neuroscience Institute, National Research Council of Italy - Cagliari Section , Monserrato , Italy
| | - Gian Luigi Gessa
- Neuroscience Institute, National Research Council of Italy - Cagliari Section , Monserrato , Italy
| | - Giancarlo Colombo
- Neuroscience Institute, National Research Council of Italy - Cagliari Section , Monserrato , Italy
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Rolland B, Paille F, Gillet C, Rigaud A, Moirand R, Dano C, Dematteis M, Mann K, Aubin H. Pharmacotherapy for Alcohol Dependence: The 2015 Recommendations of the French Alcohol Society, Issued in Partnership with the European Federation of Addiction Societies. CNS Neurosci Ther 2016; 22:25-37. [PMID: 26768685 PMCID: PMC6492872 DOI: 10.1111/cns.12489] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Revised: 10/30/2015] [Accepted: 11/03/2015] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The latest French good practice recommendations (GPRs) for the screening, prevention, and treatment of alcohol misuse were recently published in partnership with the European Federation of Addiction Societies (EUFAS). This article aims to synthesize the GPRs focused on the pharmacotherapy of alcohol dependence. METHODS A four-member European steering committee defined the questions that were addressed to an 18-member multiprofessional working group (WG). The WG developed the GPRs based on a systematic, hierarchical, and structured literature search and submitted the document to two review processes involving 37 French members from multiple disciplines and 5 non-French EUFAS members. The final GPRs were graded A, B, or C, or expert consensus (EC) using a reference recommendation grading system. RESULTS The treatment of alcohol dependence consists of either alcohol detoxification or abstinence maintenance programs or drinking reduction programs. The therapeutic objective is the result of a decision made jointly by the physician and the patient. For alcohol detoxification, benzodiazepines (BZDs) are recommended in first-line (grade A). BZD dosing should be guided by regular clinical monitoring (grade B). Residential detoxification is more appropriate for patients with a history of seizures, delirium tremens, unstable psychiatric comorbidity, or another associated substance use disorder (grade B). BZDs are only justified beyond a 1-week period in the case of persistent withdrawal symptoms, withdrawal events or associated BZD dependence (grade B). BZDs should not be continued for more than 4 weeks (grade C). The dosing and duration of thiamine (vitamin B1) during detoxification should be adapted to nutritional status (EC). For relapse prevention, acamprosate and naltrexone are recommended as first-line medications (grade A). Disulfiram can be proposed as second-line option in patients with sufficient information and supervision (EC). For reducing alcohol consumption, nalmefene is indicated in first line (grade A). The second-line prescription of baclofen, up to 300 mg/day, to prevent relapse or reduce drinking should be carried out according to the "temporary recommendation for use" measure issued by the French Health Agency (EC). During pregnancy, abstinence is recommended (EC). If alcohol detoxification is conducted during pregnancy, BZD use is recommended (grade B). No medication other than those for alcohol detoxification should be initiated in pregnant or breastfeeding women (EC). In a stabilized pregnant patient taking medication to support abstinence, the continuation of the drug should be considered on a case-by-case basis, weighing the benefit/risk ratio. Only disulfiram should be always stopped, given the unknown risks of the antabuse effect on the fetus (EC). First-line treatments to help maintain abstinence or reduce drinking are off-label for people under 18 years of age and should thus be considered on a case-by-case basis after the repeated failure of psychosocial measures alone (EC). Short half-life BZDs should be preferred for the detoxification of elderly patients (grade B). The initial doses of BZDs should be reduced by 30 to 50% in elderly patients (EC). In patients with chronic alcohol-related physical disorders, abstinence is recommended (EC). Any antidepressant or anxiolytic medication should be introduced after a psychiatric reassessment after 2-4 weeks of alcohol abstinence or low-risk use (grade B). A smoking cessation program should be offered to any smokers involved in an alcohol treatment program (grade B).
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Affiliation(s)
- Benjamin Rolland
- Société Française d'AlcoologieIssy‐les‐MoulineauxFrance
- Service d'AddictologieCHRU de LilleINSERM U1171Univ LilleLilleFrance
| | - François Paille
- Société Française d'AlcoologieIssy‐les‐MoulineauxFrance
- Service d'AddictologieCHU de NancyVandœuvre‐lès‐NancyNancyFrance
| | - Claudine Gillet
- Société Française d'AlcoologieIssy‐les‐MoulineauxFrance
- Centre d'AddictologieHôpital VilleminNancyFrance
| | - Alain Rigaud
- Société Française d'AlcoologieIssy‐les‐MoulineauxFrance
- Pôle d'addictologieEPSM MarneChâlons‐en‐Champagne et ReimsReimsFrance
- Association Nationale de Prévention en Alcoologie et Addictologue (ANPAA)ParisFrance
| | - Romain Moirand
- Société Française d'AlcoologieIssy‐les‐MoulineauxFrance
- CHU de RennesUnité d'AddictologieRennesFrance
- INSERMUMR 991RennesFrance
| | - Corine Dano
- Société Française d'AlcoologieIssy‐les‐MoulineauxFrance
- Service d'AddictologieCHU d'AngersAngersFrance
| | - Maurice Dematteis
- Société Française d'AlcoologieIssy‐les‐MoulineauxFrance
- Clinique d'AddictologieCHU de GrenobleUniversité Grenoble AlpesGrenobleFrance
| | - Karl Mann
- Central Institute of Mental HealthMedical Faculty MannheimUniversity of HeidelbergMannheimGermany
- EUFAS Scientific Secretariat Professor Antoni Gual (MD; PhD)Clinic Hospital of BarcelonaAddictive Behaviors UnitBarcelonaSpain
| | - Henri‐Jean Aubin
- Société Française d'AlcoologieIssy‐les‐MoulineauxFrance
- EUFAS Scientific Secretariat Professor Antoni Gual (MD; PhD)Clinic Hospital of BarcelonaAddictive Behaviors UnitBarcelonaSpain
- Département de Psychiatrie et d'AddictologieINSERM U1178Hôpital Paul BrousseAPHP VillejuifVillejuifFrance
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Aubin HJ, Luquiens A. Feeding Two Birds with One Scone: The Case of Varenicline. Alcohol Clin Exp Res 2015; 39:2299-301. [DOI: 10.1111/acer.12907] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 09/15/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Henri-Jean Aubin
- Paul-Brousse Hospital; AP-HP; Inserm U 1178; Paris-Sud University; Villejuif France
| | - Amandine Luquiens
- Paul-Brousse Hospital; AP-HP; Inserm U 1178; Paris-Sud University; Villejuif France
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Rolland B, Labreuche J, Duhamel A, Deheul S, Gautier S, Auffret M, Pignon B, Valin T, Bordet R, Cottencin O. Baclofen for alcohol dependence: Relationships between baclofen and alcohol dosing and the occurrence of major sedation. Eur Neuropsychopharmacol 2015; 25:1631-6. [PMID: 26095229 DOI: 10.1016/j.euroneuro.2015.05.008] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 04/29/2015] [Accepted: 05/25/2015] [Indexed: 11/29/2022]
Abstract
High-dose baclofen, i.e., 300 mg/d or more, has recently emerged as a strategy for treating alcohol dependence. The impact that the co-exposure of large amounts of alcohol and baclofen has on sedation is unclear. In a prospective cohort of 253 subjects with alcohol dependence, we collected daily alcohol and baclofen doses across the first year of baclofen treatment and the monthly maximum subjective sedation experienced by each patient (0-10 visual analog scale). For each patient-month, we determined the average weekly alcohol consumption (AWAC; standard-drinks/week) and the maximum daily dose of baclofen (DDB; mg/d). The occurrence of an episode of major sedation (EMS) during a patient-month was defined as a sedation score ≥7. The relationship between the EMS occurrence and the concurrent AWAC and DDB was investigated using a generalized estimating equation model. In total, 1528 patient-months were compiled (70 with an EMS). Univariate analyses demonstrated that the rate of patient-month to EMS increased gradually with AWAC (p<0.001), from 0.9% for AWAC=0 to 9.4% for AWAC >35. There was also a significant gradual risk for EMS associated with DDB (<0.001). Multivariate analysis demonstrated a significant interaction between DDB and AWAC on EMS risk (p=0.047). Each 20mg/d increase in DDB was associated with an OR of EMS in AWAC >35 of 1.22 (95%CI, 1.08-1.38) versus 1.11 (95%CI, 0.96-1.29) in AWAC=1-35, and 0.95 (95%CI, 0.76-1.19) in AWAC=0. The level of sedation observed in patients using baclofen for alcohol dependence appears to directly depend on the immediate doses of both the baclofen and the alcohol.
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Affiliation(s)
- Benjamin Rolland
- Department of Addiction Medicine, CHU Lille, F-59037 Lille, France; Department of Pharmacology, INSERM U 1171, Univ Lille, F-59045 Lille, France.
| | | | - Alain Duhamel
- Department of Biostatistics, CHU Lille, F-59037 Lille, France; CERIM, EA 2694, Univ Lille, F-59045 Lille, France
| | | | - Sophie Gautier
- Department of Pharmacology, INSERM U 1171, Univ Lille, F-59045 Lille, France; Department of Pharmacovigilance, F-59037 Lille, France
| | | | - Baptiste Pignon
- Department of Addiction Medicine, CHU Lille, F-59037 Lille, France
| | - Thomas Valin
- Department of Psychiatry, CH Douai F-59507, Douai, France
| | - Régis Bordet
- Department of Pharmacology, INSERM U 1171, Univ Lille, F-59045 Lille, France; CEIP, CHU Lille, F-59037 Lille, France; Department of Pharmacovigilance, F-59037 Lille, France
| | - Olivier Cottencin
- Department of Addiction Medicine, CHU Lille, F-59037 Lille, France; SCALAB UMR CNRS 9193, Univ Lille, F-59045 Lille, France
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Reichmuth P, Blanc AL, Tagan D. Unintentional baclofen intoxication in the management of alcohol use disorder. BMJ Case Rep 2015; 2015:bcr2015212187. [PMID: 26396128 PMCID: PMC4593270 DOI: 10.1136/bcr-2015-212187] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2015] [Indexed: 11/04/2022] Open
Abstract
In recent years, there has been a growing interest in using baclofen for the management of alcohol use disorder. This off-label indication usually involves high doses of the medication. We report a case of severe baclofen overdose in a 66-year-old man. The patient was found severely agitated, and he presented with delirium and auditory hallucinations. At hospital admission, his daily dose was 180 mg baclofen. He was admitted to the intensive care unit for sedation and supportive care. When sedation was withdrawn, the patient presented with a normal neurological status. In this clinical context, baclofen intoxication was suspected. This was confirmed by measuring blood baclofen levels. This intoxication was probably mediated by a combination of risk factors including a high daily dose of baclofen and acute renal failure, conducive to drug accumulation.
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Affiliation(s)
- Philipp Reichmuth
- Department of Internal Medicine, Riviera-Chablais Hospital, Vevey, Switzerland
| | - Anne-Laure Blanc
- Clinical Pharmacy, Pharmacie des Hôpitaux de l'Est Lémanique, Vevey, Switzerland
| | - Damien Tagan
- Department of Internal Medicine, Riviera-Chablais Hospital, Vevey, Switzerland
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Perogamvros L, Pépin JL, Thorens G, Mégevand P, Claudel E, Espa F, Besson M, Cervena K, Janssens JP, Lador F. Baclofen-Associated Onset of Central Sleep Apnea in Alcohol Use Disorder: A Case Report. Respiration 2015; 90:507-511. [PMID: 26390141 DOI: 10.1159/000439542] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 08/18/2015] [Indexed: 04/13/2024] Open
Abstract
A 61-year-old patient with alcohol use disorder (AUD) was referred for suspicion of sleep apnea syndrome (SAS). He had incurred three road accidents attributed to sleepiness over the previous year, shortly after initiation of high-dose (100 mg b.i.d.) treatment with baclofen, a molecule increasingly used in the management of AUD. Polysomnography revealed a severe central SAS (CSAS) with an apnea-hypopnea index (AHI) of 81.6/h. Baclofen was suggested as a possible cause of the CSAS, and after its withdrawal, a second polysomnography was done, showing the disappearance of the central apneas and a shift to severe obstructive SAS (AHI 43.9/h), for which a positive airway pressure (CPAP) treatment was initiated. A third polysomnography was performed under CPAP after reintroduction of baclofen (50 mg b.i.d.) by the patient, showing reappearance of the CSAS (AHI 42.1/h). This case report illustrates the deleterious effect of baclofen on breathing physiology during sleep. Since it is typically prescribed off label at high doses to a population of patients potentially using other substances that inhibit the ventilatory drive, this possible adverse effect is a major concern. When considering the use of baclofen in patients with AUD, the potential for sleep-disordered breathing should be weighed and carefully monitored.
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Rolland B, Mann K, Paille F, Aubin HJ. The New French Guidelines on Alcohol Misuse: An Initiative for Strengthening Cross-European Interplay. Addiction 2015; 110:1362-3. [PMID: 26173162 DOI: 10.1111/add.12997] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 05/20/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Benjamin Rolland
- French Alcohol Society, Issy-les-Moulineaux, France.,Department of Addiction Medicine, University Hospital of Lille, France.,Department of Pharmacology, INSERM U 1171, Medical Faculty of Lille, University of Lille, France
| | - Karl Mann
- Central Institute of Mental Health, European Federation of Addiction Societies, Mannheim, Germany.,Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Mannheim, Germany.,Medical Faculty Mannheim, Heidelberg University, Germany
| | - François Paille
- French Alcohol Society, Issy-les-Moulineaux, France.,Department of Addiction Treatment, University Hospital, Vandoeuvre-lès-Nancy, France
| | - Henri-Jean Aubin
- French Alcohol Society, Issy-les-Moulineaux, France.,CERTA L'Albatros, Paul Brousse Hospital, AP-HP, INSERM U 669, Villejuif, France
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Shukla L, Shukla T, Bokka S, Kandasamy A, Benegal V, Murthy P, Chand P. Correlates of Baclofen Effectiveness in Alcohol Dependence. Indian J Psychol Med 2015; 37:370-3. [PMID: 26664095 PMCID: PMC4649808 DOI: 10.4103/0253-7176.162913] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Alcohol dependence is a global concern. Baclofen has shown promise as an anti-craving agent but its efficiency remains to be settled. We reviewed 549 male cases diagnosed with alcohol dependence who received Acamprosate (201) or Baclofen (348). 'Time to first drink' was compared between two groups and multiple regression analysis was done in baclofen group to identify correlates of effectiveness. There was a significant difference in outcome measure between Baclofen (M = 4.44, SD = 3.75) and Acamprosate group (M = 3.73, SD = 2.19); t (547) = 2.45, P = 0.01. Initial regression analysis with six predictor variables (average daily alcohol units, current age, age at onset of dependence, family history, duration of dependence and dose of baclofen in mg/day) showed significant correlation of outcome variable with only two predictor variables - dose of baclofen and average daily intake. Using the hierarchical method it was found that 'dose of baclofen' and 'average alcohol intake' explain a significant amount of variance in 'time to first drink'. [F (1, 345) = 182.8, P < 0.001, R2 = 0.52, R2adjusted = 0.51]. This information can be used to select patients in long term longitudinal studies and may explain variable results seen in clinical trials of baclofen done earlier.
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Affiliation(s)
- Lekhansh Shukla
- Centre for Addiction Medicine, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Tulika Shukla
- Centre for Addiction Medicine, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Spandana Bokka
- Centre for Addiction Medicine, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Arun Kandasamy
- Centre for Addiction Medicine, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Vivek Benegal
- Centre for Addiction Medicine, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Pratima Murthy
- Centre for Addiction Medicine, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Prabhat Chand
- Centre for Addiction Medicine, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
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Rolland B, Deheul S, Danel T, Bence C, Blanquart MC, Bonord A, Semal R, Briand T, Sochala M, Dubocage C, Dupriez F, Duquesne D, Gibour B, Loosfeld X, Henebelle D, Henon M, Vernalde E, Matton C, Bacquet JE, Molmy L, Sarasy F, Simioni N, Richez C, Gentil-Spinosi L, Vosgien V, Yguel J, Ledent T, Auffret M, Wilquin M, Ziolkowski D, Sochala M, Gautier S, Bordet R, Cottencin O. La « recommandation temporaire d’utilisation » sur le baclofène : point de vue des prescripteurs du dispositif CAMTEA. Therapie 2015; 70:235-8. [DOI: 10.2515/therapie/2014210] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 10/03/2014] [Indexed: 11/20/2022]
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Abstract
INTRODUCTION There is increasing evidence encouraging the development of drugs that positively modulate the γ-aminobutyric acid type B (GABA(B)) receptor for combating addiction. Compounds that target GABA(B) receptors are unique as anti-abuse therapies because of their impact against multiple addictive drugs. AREAS COVERED The authors present the basic information concerning the drug actions of GABA and GABA(B) receptor orthosteric agonists and positive allosteric modulators (PAM). Furthermore, they discuss several recent excellent reviews and newer results pertaining to GABA(B) receptor drug effects on responses to and self-administration of: alcohol (ethanol), nicotine, cocaine, (meth)amphetamine, and opioids. Preclinical and clinical data are considered. EXPERT OPINION Clinical data exist only for baclofen and mostly for alcohol use disorders. Additional trials are needed, but effects are promising. Whether PAMs, given alone or in combination with a direct GABA(B) receptor agonist, will be clinically effective and have fewer side effects requires investigation. The sedative effects of baclofen, a Food and Drug Administration (FDA)-approved drug, become less severe over time. Based on existing data, baclofen is well-tolerated. However, genetic and physiological differences are likely to contribute to individual responses to different therapeutic agents. The more immediate development of baclofen as a therapeutic for alcohol use disorders may be of significant benefit to some individuals.
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Affiliation(s)
- Tamara J Phillips
- Oregon Health & Science University, Veterans Affairs Medical Center, Department of Behavioral Neuroscience , 3710 SW US Veterans Hospital Rd, Portland, OR 97239 , USA +1 503 220 8262 Ext. 56674 ; +1 503 721 1029 ;
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