Division 3, Department of Hepatology, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, China.
Division 3, Department of Hepatology, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, China; Division 2, Department of Hepatology, The Fourth People's Hospital of Qinghai Province, 810000, China.
J Psychiatr Res. 2023 Aug;164:477-484. doi: 10.1016/j.jpsychires.2023.06.042. Epub 2023 Jun 30.
Baclofen is the only drug that has been investigated in randomized controlled studies for anti-craving in patients with alcohol use disorder (AUD) and liver disease. However, the results of its efficacy are controversial due to limited case numbers; therefore, a meta-analysis of all available studies is needed to verify efficacy and safety in this population. This systematic review and meta-analysis were conducted according to the Cochrane Collaboration Handbook (PROSPERO ID: CRD42021284439) clauses. PubMed, Embase, Medline, Cochrane, and Clinical Trials. Gov were searched for patients with AUD co-morbid liver diseases who used baclofen to maintain abstinence. The primary outcome was maintaining abstinence. Baclofen safety was evaluated by adverse reaction occurrence during treatment. A total of 322 patients with AUD co-morbid liver diseases (alcohol-related liver disease, hepatitis C, or cirrhosis) from five studies were included. The total abstinence rate was 53% (95% CI: 0.23-0.84). Specifically, the abstinence rate in patients with alcohol-related liver disease and cirrhosis was 63% and 55%, respectively. We further analyzed the two included randomized controlled studies to compare the efficacy between baclofen and a placebo. There was no significant difference in abstinence rates between baclofen and the placebo (RR: 1.42, 95% CI: 0.41-4.92). One serious adverse event was reported, and no cases of baclofen addiction were found. The abstinence rate in patients with AUD co-morbid liver diseases was 53%; however, the efficacy of baclofen for maintaining abstinence in this population still needs to be validated with further studies.
巴氯芬是唯一一种在随机对照研究中被用于治疗酒精使用障碍（AUD）合并肝病患者的渴求的药物。然而，由于病例数量有限，其疗效的结果存在争议；因此，需要对所有可用的研究进行荟萃分析，以验证该人群的疗效和安全性。这项系统评价和荟萃分析是根据 Cochrane 协作手册（PROSPERO ID：CRD42021284439）的条款进行的。检索了 PubMed、Embase、Medline、Cochrane 和 ClinicalTrials.gov 数据库，以纳入使用巴氯芬戒酒的 AUD 合并肝病患者。主要结局是维持戒酒。通过治疗期间不良反应的发生来评估巴氯芬的安全性。共有来自五项研究的 322 名 AUD 合并肝病（酒精性肝病、丙型肝炎或肝硬化）患者纳入本研究。总的戒酒率为 53%（95%CI：0.23-0.84）。具体而言，酒精性肝病和肝硬化患者的戒酒率分别为 63%和 55%。我们进一步分析了两项纳入的随机对照研究，以比较巴氯芬与安慰剂之间的疗效。巴氯芬与安慰剂的戒酒率无显著差异（RR：1.42，95%CI：0.41-4.92）。报告了 1 例严重不良事件，未发现巴氯芬成瘾病例。AUD 合并肝病患者的戒酒率为 53%；然而，巴氯芬在该人群中维持戒酒的疗效仍需要进一步研究来验证。
