Kenna George A, Lomastro Tonya L, Schiesl Allison, Leggio Lorenzo, Swift Robert M
Department of Psychiatry and Human Behavior, Center for Alcohol and Addiction Studies, Brown University, Providence, RI 02908, USA.
Curr Drug Abuse Rev. 2009 May;2(2):135-42. doi: 10.2174/1874473710902020135.
Despite the availability of currently approved medications and various psychosocial therapies, alcohol abuse and dependence are increasingly prevalent in the United States, and carry a significant socioeconomic burden. Recently, the novel anti-epileptic topiramate has shown great promise as a new treatment for this disorder. The objective of this review is to discuss the limitations of the currently available options for treating alcohol dependence, to review the results of clinical trials assessing the efficacy of topiramate in treating alcohol dependence, and to describe the pharmacological characteristics and mechanisms of action of topiramate as related to this indication. We systematically reviewed Medline, EMBASE, Cochran Reviews and PsycINFO search terms included combinations of the terms "pharmacotherapy" "topiramate", "alcoholism" and "alcohol dependence." Searches were last updated 24 October 2008. Currently approved treatments include disulfiram, naltrexone tablets and injection, and acamprosate. Of these, naltrexone has shown the most benefit, however the effect size is small and may reach its most promising potential when combined with medical management. Alternatively, through multiple mechanisms of action, topiramate in clinical trials has demonstrated safety and efficacy in decreasing both craving and withdrawal symptoms and increasing quality of life measures among alcohol-dependent individuals. The findings of this review suggest that topiramate is a promising new option for the treatment of alcohol dependence, and may offer substantial benefits over currently approved medications. While the manufacturer will not pursue approval of an indication for the treatment of alcohol dependence, the drug will soon be available generically, making it more affordable for a greater proportion of the public.
尽管目前已有获批的药物和各种心理社会疗法，但酒精滥用和酒精依赖在美国正日益普遍，并带来了巨大的社会经济负担。最近，新型抗癫痫药物托吡酯作为治疗这种疾病的新疗法显示出巨大潜力。这篇综述的目的是讨论目前治疗酒精依赖可用方法的局限性，回顾评估托吡酯治疗酒精依赖疗效的临床试验结果，并描述托吡酯与该适应症相关的药理学特性和作用机制。我们系统检索了Medline、EMBASE、Cochrane系统评价和PsycINFO，检索词包括“药物治疗”“托吡酯”“酒精中毒”和“酒精依赖”的组合。检索最近一次更新于2008年10月24日。目前获批的治疗方法包括双硫仑、纳曲酮片和注射剂以及阿坎酸。其中，纳曲酮显示出最大益处，然而效应量较小，与医学管理相结合时可能发挥其最有前景的潜力。另外，通过多种作用机制，托吡酯在临床试验中已证明在减少酒精依赖个体的渴望和戒断症状以及提高生活质量指标方面具有安全性和有效性。这篇综述的结果表明，托吡酯是治疗酒精依赖的一种有前景的新选择，可能比目前获批的药物有更大益处。虽然制造商不会寻求批准托吡酯用于治疗酒精依赖的适应症，但该药物很快将以通用名上市，使更多公众能够负担得起。
