Center for Alcohol and Addiction Studies, Brown University, Providence, RI, USA.
CNS Neurol Disord Drug Targets. 2010 Mar;9(1):33-44. doi: 10.2174/187152710790966614.
Both preclinical and clinical research studies have shown the GABA(B) receptor agonist baclofen represents a promising treatment for alcohol dependence. Preliminary clinical studies indicate that baclofen is able to suppress withdrawal symptoms in alcohol-dependent patients affected by the alcohol withdrawal syndrome. Moreover, baclofen has shown efficacy and safety in promoting alcohol abstinence in alcohol dependent patients in two placebo-controlled trials including one in alcohol-dependent patients with liver cirrhosis. These trials also demonstrated that baclofen was associated with reductions in withdrawal-related anxiety and alcohol craving. However, more work is needed to clearly demonstrate the efficacy of baclofen and to ascertain whether efficacy is limited to certain subtypes of alcoholic patients. For example, a recent US trial failed to demonstrate a robust effect of baclofen in treating alcohol-dependent patients though the relative moderate severity of alcohol-dependence in that trial has been suggested as one factor that may have contributed to the finding. In the present review, the authors will summarize the published clinical studies on the role of baclofen in alcohol dependence and will also present some unpublished secondary analyses. Finally, the authors will discuss possible future directions to further investigate the role of baclofen in alcohol dependence (e.g., baclofen's biobehavioral mechanisms, different baclofen doses, differences in severity and in alcoholic subtypes, different formulations of baclofen, possible combination of baclofen with other medications).
临床前和临床研究均表明，GABA(B) 受体激动剂巴氯芬有望成为治疗酒精依赖的一种方法。初步临床研究表明，巴氯芬能够抑制酒精戒断综合征患者的戒断症状。此外，两项安慰剂对照试验（包括一项针对肝硬化酒精依赖患者的试验）均表明，巴氯芬在促进酒精依赖患者戒酒方面具有疗效和安全性。这两项试验还表明，巴氯芬与降低戒断相关焦虑和酒精渴求有关。然而，仍需要更多的工作来明确证明巴氯芬的疗效，并确定疗效是否仅限于某些特定类型的酒精依赖患者。例如，最近在美国进行的一项试验未能证明巴氯芬在治疗酒精依赖患者方面的显著疗效，尽管该试验中酒精依赖的相对中度严重程度被认为是导致这一发现的一个因素。在本综述中，作者将总结巴氯芬在酒精依赖中的作用的已发表临床研究，并介绍一些未发表的次要分析。最后，作者将讨论进一步研究巴氯芬在酒精依赖中的作用的可能方向（例如，巴氯芬的生物行为机制、不同剂量的巴氯芬、严重程度和酒精依赖类型的差异、巴氯芬的不同制剂、巴氯芬与其他药物的联合使用等）。
