Topiramato como coadyuvante en el tratamiento del trastorno por dependencia de alcohol en pacientes no respondedores: un estudio de 12 meses / Topiramate as add-on therapy in non-respondent alcohol dependant patients: a 12 month follow-up study

Introducción. El topiramato es un fármaco neuromodulador que posee diferentes mecanismos de acción que podrían estar implicados en la dependencia alcohólica. Se ha estudiado su utilidad tanto en estudios abiertos como en un ensayo doble ciego. Método. Se estudió en un grupo de pacientes ya en tratamiento por dependencia alcohólica (criterios CIE-10) con mala evolución (n=64) la utilidad y tolerabilidad del topiramato como coadyuvante en el programa de deshabituación mediante un estudio multicéntrico, abierto y prospectivo de 12 meses de duración. Para medir los resultados clínicos se utilizaron una escala visual de craving (EVC), una escala visual de priming (EVP), la Escala de Intensidad de dependencia alcohólica (EIDA), el número de días que bebían al mes y la cantidad bebida por el día en unidades de bebida estándar (UBE), así como parámetros analíticos como las transaminasas. Resultados. El topiramato redujo de forma significativa (p<0,001) todas las variables estudiadas, tanto las derivadas de las Escalas visuales Craving y Priming y la EIDA como el número bebidas/día y las UBE/día consumidas, así como los valores del volumen corpuscular medio y la gamma-glutamiltransferasa. La dosis media final fue algo inferior a 200 mg/día. Sólo tres pacientes abandonaron por intolerancia. Conclusiones. El topiramato mostró en condiciones asistenciales reales una buena respuesta clínica, medida tanto con la disminución de puntuación en escalas de dependencia y de craving-priming como con las bebidas referidas y las transaminasas, y parece ser un fármaco útil y bien tolerado para tratar a pacientes que presentan dependencia alcohólica y no responden adecuadamente a terapias estándar

Introduction. Topiramate is a neuromodulator drug with different action mechanisms that could be implicated in alcohol dependence. It has been studied in open and double-blind studies. Method. In a group of patients (n = 64) undergoing standard treatment for alcohol dependence (according to ICD-10 criteria) with poor outcomes, a 12 month observational, prospective and multicenter study was conducted to assess the usefulness and tolerability of topiramate as addon therapy. Outcome measures were retention rate, alcohol consumption (days of drinking per month and number of Standard Drink Units [SDU] per day, and results of Alcohol Dependence Intensity Scale [ADIS]), craving and priming visual scales and serum transaminase levels. Results. In these patients, adding topiramate leads to a significant decrease (p<0.001) in all the variables studied, including those derived from the craving and priming visual scales, the ADIS as well as the number of drinks/day and SDU/day consumed, the MCV and GGT values. Mean topiramate dose was almost 200 mg/day. Only three patients dropped out due to adverse reactions. Conclusions. Topiramate showed positive results for alcohol dependence in real clinical practice, with a significant decrease in craving-priming and dependence intensity scales, number of drinking days per month reported and transaminase levels. Topiramate seems to be a useful and well-tolerated pharmacological aid for patients with bad evolution in their alcohol dependence treatment

Topiramate as add-on therapy in non-respondent alcohol dependant patients: a 12 month follow-up study.

INTRODUCTION: Topiramate is a neuromodulator drug with different action mechanisms that could be implicated in alcohol dependence. It has been studied in open and double-blind studies. METHOD: In a group of patients (n = 64) undergoing standard treatment for alcohol dependence (according to ICD-10 criteria) with poor outcomes, a 12 month observational, prospective and multicenter study was conducted to assess the usefulness and tolerability of topiramate as addon therapy. Outcome measures were retention rate, alcohol consumption (days of drinking per month and number of Standard Drink Units [SDU] per day, and results of Alcohol Dependence Intensity Scale [ADIS]), craving and priming visual scales and serum transaminase levels. RESULTS: In these patients, adding topiramate leads to a significant decrease (p<0.001) in all the variables studied, including those derived from the craving and priming visual scales, the ADIS as well as the number of drinks/day and SDU/day consumed, the MCV and GGT values. Mean topiramate dose was almost 200 mg/day. Only three patients dropped out due to adverse reactions. CONCLUSIONS: Topiramate showed positive results for alcohol dependence in real clinical practice, with a significant decrease in craving-priming and dependence intensity scales, number of drinking days per month reported and transaminase levels. Topiramate seems to be a useful and well-tolerated pharmacological aid for patients with bad evolution in their alcohol dependence treatment.