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Baclofen in the Treatment of Alcohol Use Disorder

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Front. Psychiatry | doi: 10.3389/fpsyt.2018.00474

Baclofen for the treatment of Alcohol Use Disorder in patients with liver cirrhosis: ten years after the first evidence

Carolina Mosoni1, Tommaso Dionisi1, Gabriele Vassallo2,  Antonio Mirijello3, Claudia Tarli4, Mariangela Antonelli4, Luisa Sestito5, Maria M. Rando4, Alberto Tosoni4, Salvatore De Cosmo3, Antonio Gasbarrini4 and  Giovanni Addolorato6*
  • 1Department of Internal Medicine and Gastroenterology, Catholic University of Rome, Italy
  • 2Emergency Department, Ospedale Vincenzo Cervello, Italy
  • 3Department of Medical Sciences, Casa Sollievo della Sofferenza (IRCCS), Italy
  • 4Department of Internal Medicine and Gastroenterology, Università Cattolica del Sacro Cuore, Italy
  • 5Alcohol Use Disorder and Related Disease” Unit, Department of Internal Medicine and Gastroenterology, Università Cattolica del Sacro Cuore, Italy
  • 6Department of Internal Medicine and Gastroenterology, Catholic University of America, Rome Campus, Italy

Alcohol Use Disorder (AUD) is a chronic and relapsing condition characterized by harmful alcohol intake and behavioural-cognitive changes. AUD is the most common cause of liver disease in the Western world. Alcohol abstinence is the cornerstone of therapy in alcoholic patients affected with liver disease. Medical recommendations, brief motivational interventions and psychosocial approach are essential pieces of the treatment for these patients; however, their efficacy alone may not be enough to achieve total alcohol abstinence. The addition of pharmacological treatment could improve clinical outcomes in AUD patients. Moreover, pharmacological treatments for AUD are limited in patients with advanced liver disease, since impaired liver function affects drugs metabolism and could increase the risk of drugs-related hepatotoxicity. At present, only baclofen has been tested in RCTs in patients with advanced liver disease. This medication was effective to reduce alcohol intake, to promote alcohol abstinence and to prevent relapse in AUD patients affected by liver cirrhosis. In addition, the drug showed a safe profile in these patients.
In this review, clinical studies about efficacy and safety of baclofen administration in patients with AUD and advanced liver disease will be reviewed. Open question about the most appropriate dose of the drug, duration of the treatment and need of additional studies will also be discussed.

Keywords: alcohol use disorder, Baclofen, alcoholic liver disease, Liver Cirrhosis, Alcoholism

Received: 22 Jun 2018; Accepted: 10 Sep 2018.

Edited by:

Roberta Agabio, Università degli studi di Cagliari, Italy

Reviewed by:

Mathis Heydtmann, NHS Greater Glasgow and Clyde, United Kingdom
Nicolas Franchitto, Université Toulouse III Paul Sabatier, France
Eric Dieperink, Veterans Health Administration (VHA), United States  

Copyright: © 2018 Mosoni, Dionisi, Vassallo, Mirijello, Tarli, Antonelli, Sestito, Rando, Tosoni, De Cosmo, Gasbarrini and Addolorato. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Prof. Giovanni Addolorato, Department of Internal Medicine and Gastroenterology, Catholic University of America, Rome Campus, Rome, 00153, Lazio, Italy, giovanni.addolorato@unicatt.it