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Addolorato G, Leggio L, Ferrulli A, . Effectiveness and safety of baclofen for maintenance of alcohol abstinence in alcohol-dependent patients with liver cirrhosis: randomised, double-blind controlled study. Lancet 2007;370:1915–22.
At all stages of alcoholic liver disease (including decompensated cirrhosis) abstinence leads to substantially better clinical outcome compared with any other interventions. However, a variety of measures aimed at achieving and maintaining abstinence have had limited success.
Baclofen, a gamma aminobutyric acid (GABA) B-receptor agonist has the potential to reduce craving in patients who are alcohol-dependent. Addolorato et al randomised 84 patients with liver cirrhosis who were alcohol-dependent to either oral baclofen treatment or placebo for 12 weeks. Of 42 patients allocated baclofen, 30 (71%) achieved and maintained abstinence compared with 12 (29%) of 42 assigned to the placebo group (odds ratio 6.3; 95% CI 2.4 to 6.1; p = 0.0001). There were more dropouts (termination of treatment) in the placebo group (13/42 (31%)) than in those receiving baclofen (6/42 (14%); p = 0.12). Cumulative abstinence duration was two-fold higher in patients allocated baclofen than in those assigned to the placebo group (mean 62.8 vs 30.8 days; p = 0.001). Despite the association of GABA A-receptor ligands with hepatic encephalopathy, baclofen was well tolerated and no hepatic adverse events were …