Baclofen: its effectiveness in reducing harmful drinking, craving, and negative mood. A meta-analysis

Area of Science:

• Pharmacology
• Psychiatry
• Clinical Trials

Background:

• Limited licensed pharmacotherapies exist for alcohol use disorders (AUDs).
• Baclofen, a GABA-B agonist, is increasingly used off-label for AUD treatment.
• Evidence for baclofen's efficacy in AUDs requires rigorous evaluation.

Purpose of the Study:

• To determine the efficacy of baclofen compared to placebo in reducing drinking behavior, craving, depression, and anxiety in individuals with AUDs.
• To synthesize findings from randomized controlled trials (RCTs) on baclofen for AUDs.

Main Methods:

• A meta-analysis of 12 RCTs comparing baclofen with placebo was conducted.
• Outcome measures included drinking-related variables (heavy drinking days, abstinent days, abstinence rates) and secondary measures (craving, anxiety, depression).
• Random-effects meta-analyses were used to compute outcome data.

Main Results:

• Baclofen significantly increased abstinence rates (OR = 2.67, P = 0.04) in intention-to-treat analysis.
• No significant effects were observed for heavy drinking days (SMD = -0.26, P = 0.21).
• Baclofen did not significantly reduce craving (SMD = -0.13, P = 0.24), anxiety, or depression, with substantial heterogeneity across analyses.

Conclusions:

• Baclofen is associated with higher abstinence rates compared to placebo in AUD treatment.
• However, baclofen does not demonstrate superior effects on reducing heavy drinking, craving, anxiety, or depression.
• The current widespread off-label use of baclofen for AUDs may be premature given the evidence.