Department of Pharmacy Practice, Campbell University School of Pharmacy and Health Sciences, Buies Creek, NC, USA.
CNS Drugs. 2012 Jan 1;26(1):69-78. doi: 10.2165/11597320-000000000-00000.
The pharmacological properties of baclofen, a GABA(B) receptor agonist, have led to investigation of its use for the off-label treatment of alcohol dependence. Literature examining the role of baclofen in alcohol dependence suggests that it may be a useful medication in the treatment armamentarium with an additional benefit of promoting abstinence and reducing alcohol-associated cravings and anxiety. We conducted a systematic review of prospective, randomized controlled trials comparing baclofen with placebo for the treatment of alcohol dependence. Four randomized controlled trials were identified but only three met criteria for inclusion. The excluded trial was a post hoc analysis of data collected from an original trial whose primary outcome did not fit our inclusion criteria and was terminated prior to completion. Compared with placebo, subjects randomized to baclofen experienced higher rates of abstinence and lower anxiety scores; the effect of baclofen was statistically significant in two trials assessing patients with more severe alcohol dependence and non-significant in a trial of outpatients receiving concomitant manualized psychotherapy. Baclofen appeared to be safe, well tolerated and to have low addiction liability even in the setting of moderate-to-severe liver cirrhosis, a known complication of alcohol dependence. Though baclofen may hold promise, the different outcomes and sample populations of the three studies highlight the need for more research to better understand the appropriate target patient population to benefit from this medication. Questions still remain about optimal dosing and duration. There is not enough evidence to support the use of baclofen as a first-line treatment option, except for those alcohol-dependent patients with moderate-to-severe liver cirrhosis in whom other pharmacological treatments are not safe or practical.
巴氯芬是一种 GABA（B）受体激动剂，具有药理学特性，因此被研究用于治疗酒精依赖的非适应证。研究表明，巴氯芬可能是一种有用的药物，可以作为治疗方法之一，具有促进戒酒、减少与酒精相关的渴望和焦虑的额外益处。我们对比较巴氯芬与安慰剂治疗酒精依赖的前瞻性、随机对照试验进行了系统评价。确定了四项随机对照试验，但只有三项符合纳入标准。被排除的试验是对原始试验数据的事后分析，其主要结局不符合我们的纳入标准，并且在完成之前提前终止。与安慰剂相比，接受巴氯芬治疗的受试者戒酒率更高，焦虑评分更低；在两项评估更严重酒精依赖患者的试验中，巴氯芬的效果具有统计学意义，而在一项接受同时进行的手工心理治疗的门诊患者的试验中，效果不显著。巴氯芬似乎安全、耐受良好，即使在中度至重度肝硬化（酒精依赖的已知并发症）的情况下，成瘾性也较低。尽管巴氯芬可能有一定的前景，但三项研究的不同结果和样本人群突显了需要进一步研究，以更好地了解从这种药物中受益的合适目标患者人群。关于最佳剂量和持续时间的问题仍然存在。除了那些患有中度至重度肝硬化的酒精依赖患者外，尚无足够的证据支持将巴氯芬作为一线治疗选择，因为其他药物治疗在这些患者中不安全或不实用。
