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Baclofen for alcohol use disorder—a systematic meta‐analysis
Author(s) -
Bschor T.,
Henssler J.,
Müller M.,
Baethge C.
Publication year - 2018
Publication title -
acta psychiatrica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.849
H-Index - 146
eISSN - 1600-0447
pISSN - 0001-690X
DOI - 10.1111/acps.12905
Subject(s) - baclofen , meta analysis , alcohol use disorder , alcohol , psychiatry , medicine , psychology , clinical psychology , biochemistry , chemistry , receptor , agonist
Objective To evaluate the efficacy and tolerability of baclofen vs. placebo for long‐term treatment of alcohol use disorder. Method Systematic review and meta‐analysis following methods of the Cochrane Collaboration Handbook ( PROSPERO registration: CRD 42017073663). Primary outcome was the random‐effects summary estimate of all standardized mean differences ( SMD s), as calculated from the primary outcomes of each study. Results Fourteen double‐blind RCT s (1522 patients) were included. Heterogeneity was substantial for most analyses ( I 2 about 75%). Baclofen showed a small, but not statistically significant superiority over placebo: SMD = 0.22 ([95% CI: −0.03; 0.47], P = 0.09). This result was supported by a leave‐one‐out‐analysis, and Orwin's fail‐safe N , by predefined secondary analyses (on abstinence rates and amount of drinking), and by a post hoc‐analysis of high‐dose studies (>80 mg/day). An analysis of low risk of bias studies (SMD = 0.10 [−0.20; 0.41], P = 0.51, I 2 = 43.3%) found no effect. Exclusion of four studies focusing on patients with comorbidity yielded a small positive effect. Drop‐out rates were similar. Conclusion Our results question baclofen's utility in the long‐term treatment of alcohol use disorder at both normal and high doses. While the confidence intervals indicate that marginally harmful or moderately beneficial effects of baclofen remain a possibility, the most likely effect size is slightly above placebo effects.