Baclofen for alcohol use disorder-a systematic meta-analysis.

Area of Science:

• Pharmacology and Addiction Medicine
• Evidence-Based Medicine
• Clinical Trial Analysis

Background:

• Alcohol use disorder (AUD) is a chronic relapsing brain condition.
• Long-term treatment options for AUD are continuously being investigated.
• Baclofen, a GABA-B agonist, has been explored for its potential in treating AUD.

Purpose of the Study:

• To evaluate the efficacy and tolerability of baclofen compared to placebo for the long-term management of alcohol use disorder.
• To synthesize evidence from randomized controlled trials (RCTs) on baclofen for AUD treatment.

Main Methods:

• A systematic review and meta-analysis was conducted following Cochrane Collaboration Handbook guidelines.
• Fourteen double-blind randomized controlled trials involving 1522 patients were included in the analysis.
• The primary outcome measure was the standardized mean difference (SMD) comparing baclofen to placebo.

Main Results:

• Baclofen demonstrated a small, non-statistically significant superiority over placebo (SMD = 0.22, P = 0.09).
• Substantial heterogeneity was observed across most analyses (I² ≈ 75%).
• Analyses of low risk of bias studies and high-dose baclofen studies did not reveal a significant effect; dropout rates were similar between groups.

Conclusions:

• The current evidence questions the utility of baclofen for long-term alcohol use disorder treatment at standard and high doses.
• While a small beneficial effect cannot be entirely ruled out, the most likely effect size is minimal.
• Further investigation may be warranted, particularly in specific patient populations, to fully elucidate baclofen's role in AUD management.