Charleston, SC—A commonly prescribed drug used to treat nerve pain appears to also be useful in the treatment of patients with alcohol-use disorder and a history of alcohol-withdrawal symptoms.

A report in JAMA Internal Medicine discusses the results of a randomized clinical trial in which gabapentin—compared with placebo—significantly increased the number of people with total abstinence and reduced drinking.

Medical University of South Carolina–led researchers point out that the effect was most significantly observed in those with greater pretreatment alcohol-withdrawal symptoms. In fact, they note, 41% of participants with high alcohol-withdrawal symptoms had total abstinence on gabapentin compared with just 1% of participants in the placebo arm.

“This study showed that gabapentin is efficacious in promoting abstinence and reducing drinking in individuals with alcohol use disorder and especially so in those with more alcohol withdrawal symptoms,” the authors write.

Background information in the article describes how, although an estimated 30 million people meet criteria for alcohol use disorder (AUD), very few receive appropriate pharmacotherapy. The authors add, “A more personalized, symptom-specific, approach might improve efficacy and acceptance.”

That view led to the trial examining whether gabapentin would be useful in the treatment of AUD, especially in those having the most alcohol-withdrawal symptoms.

The study team conducted the double-blind, randomized clinical trial between November 2014 and June 2018. To evaluate gabapentin versus placebo, community-recruited participants were screened and treated in an academic outpatient setting over a 16-week treatment period.

Those screened included 145 treatment-seeking individuals who met Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) criteria for AUD and were not receiving other AUD intervention and 96 who also met recent alcohol-withdrawal criteria. All were randomized to treatment after 3 abstinent days.

Participants received either gabapentin up to 1,200 mg/d, orally, or placebo, as well as nine 20-minute medical-management visits. Ultimately, the study involved 44 patients in the gabapentin arm and 46 in the placebo arm, with a mean (SD) age of 49.6 years. Most, 77%, were men and 94% were white. The evaluable participants had 83% baseline heavy drinking days (4 or more drinks/day for women, 5 or more for men) and met 4.5 alcohol withdrawal criteria from the DSM-5, according to the report.

Records were kept of daily drinking, and researchers also collected information on the percentage of disialo carbohydrate-deficient transferrin in the blood, a heavy-drinking marker, at baseline and monthly during treatment.

The authors write that the percentage of individuals with no heavy drinking days and those with total abstinence were compared between treatment groups and further evaluated based on prestudy alcohol-withdrawal symptoms.

Results indicate that more gabapentin-treated participants entirely avoided heavy drinking days (12 of 44 participants [27%]) compared with placebo (4 of 46 participants [9%]), a difference of 18.6% (95% CI, 3.1-34.1; P = .02. Researchers calculated the number needed to treat [NNT] as 5.4). Gabapentin-treated patients also had more total abstinence (8 of 44 [18%]) compared with placebo (2 of 46 [4%]), a difference of 13.8% (95% CI, 1.0-26.7; P = .04; NNT, 6.2).

The article describes how the prestudy high alcohol–withdrawal group had positive gabapentin effects on no heavy-drinking days (P <.02; NNT, 3.1) and total abstinence (P = .003; NNT, 2.7) compared with placebo. Within the low alcohol–withdrawal group, however, no significant differences were detected.

“These findings were similar for other drinking variables, where gabapentin was more efficacious than placebo in the high–alcohol withdrawal group only. Gabapentin caused more dizziness, but this did not affect efficacy,” researchers point out.

The research team calls for future studies to evaluate sleep changes and mood during early recovery as mediators of gabapentin efficacy.

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