Topiramate for Treating Alcohol Dependence

A Randomized Controlled Trial

  • Johnson, Bankole A. DSc, MD, PhD
  • Rosenthal, Norman MD
  • Capece, Julie A. BA
  • Wiegand, Frank MD
  • Mao, Lian PhD
  • Beyers, Karen MS
  • McKay, Amy PharmD
  • Ait-Daoud, Nassima MD
  • Anton, Raymond F. MD
  • Ciraulo, Domenic A. MD
  • Kranzler, Henry R. MD
  • Mann, Karl MD
  • O'Malley, Stephanie S. PhD
  • Swift, Robert M. MD, PhD
JAMA: The Journal of the American Medical Association 298(14):p 1641-1651, October 2007.

Context

Hypothetically, topiramate can improve drinking outcomes among alcohol-dependent individuals by reducing alcohol's reinforcing effects through facilitation of γ-aminobutyric acid function and inhibition of glutaminergic pathways in the corticomesolimbic system.

Objective

To determine if topiramate is a safe and efficacious treatment for alcohol dependence.

Design, Setting, and Participants

Double-blind, randomized, placebo-controlled, 14-week trial of 371 men and women aged 18 to 65 years diagnosed with alcohol dependence, conducted between January 27, 2004, and August 4, 2006, at 17 US sites.

Interventions

Up to 300 mg/d of topiramate (n = 183) or placebo (n = 188), along with a weekly compliance enhancement intervention.

Main Outcome Measures

Primary efficacy variable was self-reported percentage of heavy drinking days. Secondary outcomes included other self-reported drinking measures (percentage of days abstinent and drinks per drinking day) along with the laboratory measure of alcohol consumption (plasma γ-glutamyltransferase).

Results

Treating all dropouts as relapse to baseline, topiramate was more efficacious than placebo at reducing the percentage of heavy drinking days from baseline to week 14 (mean difference, 8.44%; 95% confidence interval, 3.07%–13.80%; P = .002). Prespecified mixed-model analysis also showed that topiramate compared with placebo decreased the percentage of heavy drinking days (mean difference, 16.19%; 95% confidence interval, 10.79%–21.60%; P < .001) and all other drinking outcomes (P < .001 for all comparisons). Adverse events that were more common with topiramate vs placebo, respectively, included paresthesia (50.8% vs 10.6%), taste perversion (23.0% vs 4.8%), anorexia (19.7% vs 6.9%), and difficulty with concentration (14.8% vs 3.2%).

Conclusion

Topiramate is a promising treatment for alcohol dependence.

Trial Registration

clinicaltrials.gov Identifier: NCT00210925

Copyright © 2007 by the American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use. American Medical Association, 515 N. State St, Chicago, IL 60610.
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