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Clinical Pharmacy and Pharmacology

Efficacy of Gabapentin for the Treatment of Alcohol Use Disorder in Patients With Alcohol Withdrawal SymptomsA Randomized Clinical Trial

Educational Objective
To examine whether gabapentin would be useful in the treatment of alcohol use disorder (AUD), especially in those with the most alcohol withdrawal symptoms.
1 Credit CME
JAMA Internal Medicine
May 1, 2020
Original Investigation
Raymond F. Anton, MD1;
Patricia Latham, PhD1;
Konstantin Voronin, MD, PhD1;
Sarah Book, MD1;
Michaela Hoffman, PhD1;
James Prisciandaro, PhD1;
Emily Bristol, BA1
Author Affiliations
  • 1Addiction Sciences Division, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston
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Key Points

Question  Is gabapentin efficacious in the treatment of alcohol use disorder in adults with a history of alcohol withdrawal symptoms?

Findings  In this randomized clinical trial, gabapentin compared with placebo significantly increased the number of people with total abstinence and reduced drinking. This effect was most significantly observed in those with greater pretreatment alcohol withdrawal symptoms—41% of participants with high alcohol withdrawal symptoms had total abstinence on gabapentin compared with 1% of participants in the placebo arm.

Meaning  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.

Abstract

Importance  Although an estimated 30 million people meet criteria for alcohol use disorder (AUD), few receive appropriate pharmacotherapy. A more personalized, symptom-specific, approach might improve efficacy and acceptance.

Objective  To examine whether gabapentin would be useful in the treatment of AUD, especially in those with the most alcohol withdrawal symptoms.

Design, Setting, and Participants  This double-blind randomized clinical trial conducted between November 2014 and June 2018 evaluated gabapentin vs placebo in community-recruited participants screened and treated in an academic outpatient setting over a 16-week treatment period. A total of 145 treatment-seeking individuals who met Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) criteria for AUD and were not receiving other AUD intervention were screened, and 96 who also met recent alcohol withdrawal criteria were randomized to treatment after 3 abstinent days. Daily drinking was recorded, and percentage of disialo carbohydrate-deficient transferrin in the blood, a heavy drinking marker, was collected at baseline and monthly during treatment.

Interventions  Gabapentin up to 1200 mg/d, orally, vs placebo along with 9 medical management visits (20 minutes each).

Main Outcomes and Measures  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  Of 96 randomized individuals, 90 were evaluable (44 in the gabapentin arm and 46 in the placebo arm), with a mean (SD) age of 49.6 (10.1) years; 69 were men (77%) and 85 were white (94%). 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 Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition). More gabapentin-treated individuals had no 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; number needed to treat [NNT], 5.4), and 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 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, while within the low–alcohol withdrawal group, there were no significant differences. 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.

Conclusions and Relevance  These data, combined with others, suggest gabapentin might be most efficacious in people with AUD and a history of alcohol withdrawal symptoms. Future studies should evaluate sleep changes and mood during early recovery as mediators of gabapentin efficacy.

Trial Registration  ClinicalTrials.gov Identifier: NCT02349477

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Clinical Pharmacy and Pharmacology Psychiatry and Behavioral Health Addiction Medicine Alcohol
Article Information

Accepted for Publication: January 23, 2020.

Corresponding Author: Raymond F. Anton, MD, Addiction Sciences Division, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President St, MSC 861, Charleston, SC 29425 (antonr@musc.edu).

Published Online: March 9, 2020. doi:10.1001/jamainternmed.2020.0249

Author Contributions: Drs Anton and Hoffman had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Study concept and design: Anton.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Anton, Book, Bristol.

Critical revision of the manuscript for important intellectual content: Anton, Latham, Voronin, Book, Hoffman, Prisciandaro.

Statistical analysis: Anton, Hoffman, Prisciandaro.

Obtained funding: Anton.

Administrative, technical, or material support: Anton, Latham, Voronin, Book, Prisciandaro, Bristol.

Study supervision: Anton, Book, Prisciandaro.

Conflict of Interest Disclosures: Dr Anton reported receiving grants from the National Institute on Alcohol Abuse and Alcoholism during the conduct of the study; receiving grants and consulting fees from Laboratorio Farmaceutico CT; receiving consulting fees from Alkermes, Allergan, Indivior, Insys, Life Epigenetics, XenoPort (Arbor Pharmaceuticals), and Alcohol Clinical Trials Initiative (ACTIVE) outside the submitted work; and serving as a member and chair of ACTIVE, which was partially supported by Alkermes, Amygdala Neurosciences, Arbor Pharmaceuticals, Ethypharm, Indivior, Lundbeck, Mitsubishi, and Otsuka. Dr Book reported receiving grants from the National Institutes of Health during the conduct of the study. Dr Prisciandaro reported receiving grants and consulting fees from Farmaceutico Italiano and consulting fees from Laboratorio Farmaceutico CT outside the submitted work. No other disclosures were reported.

Funding/Support: Funding for this work was provided by the National Institute on Alcohol Abuse and Alcoholism (grant R01AA022364).

Role of the Funder/Sponsor: The National Institute on Alcohol Abuse and Alcoholism had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Data Sharing Statement: See Supplement 3.

Additional Contributions: Mark Ghent, BA, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, assisted in data collection, and Patrick Randall, PhD, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, assisted in initial power analyses and analytic planning and were compensated for their work.

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