barcelona . spain - European Association for the Study of the Liver

BARCELONA . SPAIN
52 POSTGRADUATE COURSE SYLLABUS ALCOHOLIC LIVER DISEASE 53
APRIL 18 - 19/2012 THE INTERNATIONAL LIVER CONGRESS TM 2012
NOTES
disulfiram. The most promising drug for the maintenance of abstinence in alcoholic cirrhotic patients is
baclofen. Baclofen is an agonist of the GABA B
receptor which has demonstrated to be more effective than
placebo in promoting alcohol abstinence in a study on 84 cirrhotic patients treated with baclofen or placebo
for 12 weeks (16). Mean cumulative abstinence duration was 62.8 days in baclofen-treated patients as
compared to 30.8 days in the placebo group. The safety profile of baclofen was good and no case of
hepatotoxicity has been reported. Moreover, it is important to underline that patients with decompensated
cirrhosis were included (38 and 43% of patients were Child-Pugh C in each group respectively). Another
key-point of the management of alcohol dependence is brief interventions that must incorporate the features
defined in the five As’ model: Ask about use, Advice to quit or reduce, Assess willingness, Assist to quit or
reduce and Arrange follow up. These brief interventions have shown to reduce the amount of alcohol of
more than 50 g per week in men in a recent meta-analysis (17).
Anton RF, O’Malley SS, Ciraulo DA, Cisler RA, Couper D, Donovan DM, Gastfriend DR, et al.
Combined pharmacotherapies and behavioral interventions for alcohol dependence: the COMBINE
study: a randomized controlled trial. Jama 2006;295:2003-2017.
Addolorato G, Leggio L, Ferrulli A, Cardone S, Vonghia L, Mirijello A, Abenavoli L, et al.
Effectiveness and safety of baclofen for maintenance of alcohol abstinence in alcohol-dependent
patients with liver cirrhosis: randomised, double-blind controlled study. Lancet 2007;370:1915-1922.
Kaner EF, Dickinson HO, Beyer F, Pienaar E, Schlesinger C, Campbell F, Saunders JB, et al. The
effectiveness of brief alcohol interventions in primary care settings: a systematic review. Drug
Alcohol Rev 2009;28:301-323.
In this patient, alcohol dependence must be evaluated using the AUDIT score and brief interventions are to
be encouraged. If a pharmacological support is needed, baclofen is the drug of choice, when considering
the probable underlying cirrhosis.
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