Baclofen for Alcohol Use Disorder: Efficacy Unclear at Best, Harms Becoming Clearer

Despite mixed evidence, baclofen continues to be used to treat alcohol use disorder (AUD) by some, particularly in France. Investigators analyzed data from French Health Insurance claims to assess the risk for hospitalization and death associated with initiating AUD medications.

• Some 165,334 patients started acamprosate, nalmefene, naltrexone, or baclofen between 2009 and 2015. Excluded were patients with medication treatment for opioid use disorder, an elevated one-year mortality risk, and with a neurological condition that could be associated with muscle spasms (that might be treated with baclofen).
• In analyses adjusted for sociodemographics, physician specialty, psychiatric medications, alcohol-related hospitalization, and comorbidity, baclofen—compared with the other medications—was associated with hospitalization (hazard ratio [HR], 1.1) and mortality (HR, 1.3).
• There was a dose-response relationship with higher doses of baclofen associated with greater risk.

Comments: Patients and clinicians are interested in a medication to treat AUD that has no liver toxicity and that has more than minimal efficacy. Baclofen is not that medication. Prior study results do not convincingly demonstrate efficacy, and the current study suggests very real harms.

Richard Saitz, MD, MPH

Reference: Chaignot C, Zureik M, Rey G, et al. Risk of hospitalisation and death related to baclofen for alcohol use disorders: Comparison with nalmefene, acamprosate, and naltrexone in a cohort study of 165 334 patients between 2009 and 2015 in France. Pharmacoepidemiol Drug Saf. 2018;27:1239–1248.