A prospective cohort study examining the effectiveness of baclofen in the maintenance of abstinence in alcohol use disorder patients attending a joint liver and alcohol treatment clinic

Objective: Alcohol-related liver disease (ARLD) is the leading cause of alcohol-related mortality in the UK. Helping patients with ARLD to stop drinking is an important treatment goal. The aim of this study is to explore baclofen's utility in maintaining abstinence. Methods a prospective cohort study: Patients with ARLD were commenced on baclofen; the dose was titrated according to tolerability and response up to 30 mg three times daily. Severity of physical dependence and biochemical markers of liver injury were assessed at baseline, 3 months, and 12 months. Results: Length of follow-up differed. Of 219 patients in the original cohort, 186 and 113 were evaluated at 3 months and 12 months, respectively. Loss to follow-up was due to death, baclofen non-adherence, and failure to attend appointments. Comparison of baseline and 1-year biochemical markers showed significant reductions in GGT (median change = 82.0; 95% CI = -149.0 to -40.0; p < 0.0005), ALT (-10.5; 95% CI = -16.5 to -5.0; p = 0.001), and bilirubin (-4.5; 95% CI = -7.0 to -2.0; p < 0.001). The proportion of eligible patients reporting complete abstinence at 3 and 12 months was 55% and 53%, respectively. A significant reduction in alcohol consumption and Severity of Alcohol Dependence Questionnaire score was observed at both follow-up time points. Conclusion: Adherence to the baclofen was good, and it had a positive impact on measures of alcohol consumption. A limitation of our study is its observational nature. Further randomized studies alongside investigation of dosing strategies are required. (C) 2017 Elsevier Inc. All rights reserved.