BARCELONA – Pregabalin reduced alcohol craving scores just as effectively as did naltrexone and was associated with a longer period of alcohol abstinence, especially in patients with a comorbid psychiatric disorder, according to the first randomized comparison trial of the two drugs.
Pregabalin also positively affected anxiety, hostility, and psychoticism–additional benefits for patients with a combination of alcohol and psychiatric problems, Dr. Giovanni Martinotti reported in a poster at the annual congress of the European College of Neuropsychopharmacology.
“The mechanisms involved in the efficacy of pregabalin could be less related to craving for alcohol and more connected to the treatment of these comorbid psychiatric disorders,” wrote Dr. Martinotti of Catholic University's treatment unit for alcoholism and multiple drug abuse, Rome.
His 16-week study included 59 alcohol-dependent patients, with a mean of 15 years' alcohol addiction; their mean daily alcohol consumption was 8 drinks. These patients (mean age 40 years) were detoxified over 5-10 days, and then randomized to either naltrexone 50 mg daily (28) or pregabalin at an average dose of 275 mg daily (31).
No significant differences in craving scores were found over the treatment period. More patients taking pregabalin remained alcohol free for the entire study (15 vs. 11) and, although this was not statistically significant, a survival curve showed that those taking pregabalin remained abstinent for a significantly longer period. There were no significant differences in posttreatment relapses.
Patients taking pregabalin showed significantly lower withdrawal scores than did those taking naltrexone, with the difference apparent in as little as 2 weeks.
Psychiatric symptoms were assessed with the Symptom Checklist 90-Revised. By this measure, those taking pregabalin showed significant decreases in the general “positive symptoms total” index, as well as in the subscales for phobic anxiety, hostility, and psychoticism, he wrote.
Among those patients with a dual diagnosis of alcohol-use disorder and a psychiatric disorder, pregabalin was associated with a significantly higher total abstinence score than was naltrexone (50% vs. 15%).
“If it could be confirmed in placebo-controlled trials that pregabalin is efficacious in decreasing alcohol use, lessening craving, and attenuating psychopathological symptom severity, we will have gained a valuable agent for the treatment of alcohol-dependent subjects,” Dr. Martinotti wrote.
Dr. Martinotti said he had no disclosures to make regarding the study.