Gabapentinoids for treatment of alcohol use disorder: A systematic review and meta‐analysis

Abstract

Objective Gabapentin (GBP) and pregabalin (PGB) have been used to treat alcohol use disorder (AUD) and alcohol withdrawal, but with inconsistent results. In this meta‐analysis, we explored the effects of GBP/PGB treatment on AUD and their effects on withdrawal, craving, depression, and sleep disturbance in AUD patients. Methods We carried out a systematic review and meta‐analysis of randomized controlled trials comparing the effects of GBP/PGB on AUD with those of a placebo or control treatment. Electronic databases were searched for relevant articles published before September 2019. The primary outcome was defined as the efficacy measure on achieving abstinence or reducing alcohol consumption in a hierarchical order. We included 16 studies in our meta‐analysis. Results Overall, GBP had no significant benefit comparing to placebo or control treatment (Hedges' g = 0.0725, p = 0.6743). For specific alcohol‐related outcome, GBP had significant effect on percentage of heavy drink (Hedges' g = 0.5478, p = 0.0441) and alcohol withdrawal symptoms (Hedges' g = 0.2475, p = 0.0425). GBP/PGB did not have significant beneficial effect on craving, depressive symptoms, or sleep disturbance. Instability was shown in sensitivity analyses of some above results. Conclusions GBP may be helpful to reduce AUD patients' heavy drinking behavior and withdrawal, but more studies are needed for drawing conclusions.

The efficacy of psychotherapies and pharmacotherapies for mental disorders in adults: an umbrella review and meta‐analytic evaluation of recent meta‐analyses

“…For psychotherapy, the effect size decreased at follow‐ups ≥8 months after end of treatment (SMD=0.05) 96 . Considering all meta‐analyses, small effect sizes were found for pharmacotherapy (SMDs: 0.07 to 0.35, RR: 0.32‐1.39) 94,95 .…”

“…One hundred and two meta‐analyses fulfilled the inclusion criteria (see Figure 1 and supplementary information). These encompassed 69 meta‐analytic comparisons of pharmacotherapies with placebo or TAU, 26 comparisons of psychotherapies with placebo or TAU, 11 comparisons of psychotherapies vs. pharmacotherapies head‐to‐head, and 13 comparisons of combined psychotherapy and pharmacotherapy to either monotherapy 6,12,13,34‐134 . The 102 meta‐analyses encompassed 3,782 RCTs (range: 2 to 522) and 650,514 patients (range: 65 to 116,477) (see supplementary information).…”

“…Considering all meta-analyses, small effect sizes were found for pharmacotherapy (SMDs: 0.07 to 0.35, RR: 0.32-1.39) 94,95 .…”

Nutritional Ketosis as a Potential Treatment for Alcohol Use Disorder

“…However, there is risk of dependence on benzodiazepines, particularly among patients with AUD, which precludes their use in this population beyond the period of acute withdrawal ( 3 ). Although anticonsulvants have also been shown to be efficacious in treating AWS and have less potential for dependence, these medications have a number of adverse effects ( 4 , 5 ). Thus, additional efficacious treatments are needed that have less dependence potential and adverse effects than existing medications.…”

Comment on “Abuse and Misuse of Pregabalin and Gabapentin: A Systematic Review Update”

“…Also, among the substance-abusing populace, GPs demonstrate positive benefit in terms of amelioration of withdrawal symptoms from alcohol (EBM-levels II-Ia [15][16][17][18][19]) or opioid dependence (EBM-levels II-Ib) [19,20]) and per one randomized trial, also cannabis dependence (EBMlevel Ib [21]). This is important from a clinical standpoint in that withdrawal is one of the main triggers for relapse to substance dependence, and in that context, GP may serve as a significant therapeutic modality in addiction medicine Fig.…”