A meta‐analysis of the efficacy of gabapentin for treating alcohol use disorder

Abstract

Background and AimsStudies of the efficacy of gabapentin for treating alcohol use disorder (AUD) have yielded mixed findings. The aims of our study were to estimate gabapentin's effects on six alcohol‐related outcomes, test potential moderators, examine publication bias and evaluate the quality of the studies.MethodsMeta‐analysis of placebo‐controlled randomized controlled trials (RCTs). Using PubMed and ClinicalTrials.gov, we selected RCTs of gabapentin's effects on alcohol consumption or a biochemical correlate of it, excluding studies limited to other primary outcomes or that combined gabapentin with other medications. We assessed study quality and used a random‐effects model to analyze each outcome measure and the Egger regression test and funnel plots to assess publication bias.ResultsWe identified seven RCTs of gabapentin that met study criteria. The quality of the studies overall was good, and there was no evidence of publication bias. Four to seven studies contributed to the analysis of the six outcome measures. For all outcome measures the effect estimates were in a direction that favored gabapentin over placebo. However, only for percentage of heavy drinking days was there good evidence of a benefit (g = −0.64, 95% confidence interval = −1.22 to −0.06).ConclusionsAlthough gabapentin appears to be more efficacious than placebo in treating AUD, the only measure on which the analysis clearly favors the active medication is percentage of heavy drinking days. Additional studies are needed to define more clearly the role of gabapentin in AUD treatment.

Survey of Addiction Specialists’ Use of Medications to Treat Alcohol Use Disorder

“…Survey responses also showed that addiction specialists are not comfortable ordering pharmacogenetic testing, do not believe that they have access to genetics expertise, and do not feel that they have adequate training in pharmacogenetics. Current research on treating AUD focuses on identifying genetic factors that could influence AUD treatment decisions (22), but those advances will need to be accompanied by efforts to increase providers' comfort with and knowledge of pharmacogenetic testing. CME courses on pharmacogenetics may be the most effective way to disseminate clinical genetics expertise rapidly and integrating principles of pharmacogenetics into training programs can help to prepare future generations of providers to handle this emerging approach to diagnosis and treatment.…”

Gabapentin Enacarbil Extended‐Release Versus Placebo: A Likely Responder Reanalysis of a Randomized Clinical Trial

“…In a meta‐analysis of gabapentin for AUD, Kranzler and colleagues (2019) reported limited benefits and called for additional studies to define more clearly the role of gabapentin in AUD treatment. We reanalyzed a multisite 26‐week randomized double‐blind placebo‐controlled clinical trial (Falk et al, 2019) of 600 mg twice‐a‐day gabapentin enacarbil extended‐release, a gabapentin prodrug, designed to evaluate safety and efficacy in reducing heavy drinking in alcohol use disorder.…”

“…Alcoholism typologies appear to have some influence on response to selective serotonin uptake inhibitors on drinking outcomes (Pettinati et al, 2000; Kranzler et al, 1996; Chick et al, 2004). Single genetic polymorphisms have been shown to influence response to ondansetron (Johnson et al, 2011) and topiramate (Kranzler, Feinn, Morris, Hartwell, 2019), while studies of the effect of the Asn40Asp polymorphism of the mu opioid receptor gene have been nonconclusive (Hartwell et al, 2020). A secondary analysis by Hou and colleagues (2015) of the Johnson and colleagues (2011) study referenced above used reduction of baseline PHDD (ΔPHDD, i.e., change in average PHDD during treatment period relative to baseline) as the primary outcome.…”

“…Previous clinical trials have been inconsistent in the appraisal of the efficacy of gabapentin for treating AUD (Roberto et al, 2008; Anton et al, 2011; Mason et al, 2014; Falk et al, 2019). A recent meta‐analysis by Kranzler and colleagues (2019) found that there was evidence of a benefit only for 1 outcome variable, percentage of HDD (PHDD).…”

Stress Allostasis in Substance Use Disorder: Promise, Progress, and Emerging Priorities

“…Gabapentin has produced mixed effects on clinical outcomes for AUD. However, a recent metaanalysis of seven randomized controlled trials (RCTs) concluded that gabapentin reduced percentage of heavy drinking days but none of the other five clinical outcomes considered (Kranzler et al 2019). With respect to other SUDs, one small-N RCT demonstrated preliminary efficacy of gabapentin for cannabis use (Mason et al 2012).…”