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Safety and drinking outcomes among patients with comorbid alcohol dependence and borderline personality disorder treated with high-dose baclofen: a comparative cohort study

Rolland, Benjamina,b,f; Valin, Thomash; Langlois, Carolec; Auffret, Marinea,d; Gautier, Sophiea,d,f; Deheul, Sylviea,d; Danel, Thierrya,e,f; Bordet, Régisa,d,f; Cottencin, Oliviera,b,g

International Clinical Psychopharmacology: January 2015 - Volume 30 - Issue 1 - p 49–53
doi: 10.1097/YIC.0000000000000054
ORIGINAL ARTICLES
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In France, the off-label use of high-dose baclofen (HDB) for alcohol dependence is spreading. HDB induces frequent neuropsychiatric adverse events (AEs). Borderline personality disorder (BPD) is a major axis-two psychiatric disorder that exposes to frequent comorbid alcohol dependence and increased risky behaviors. We investigated the drinking and safety outcomes of patients with BPD treated with HDB for comorbid alcohol dependence. In a prospective cohort of 204 patients with alcohol dependence treated by HDB, 23 patients fulfilled the Diagnostic and Statistical Manual of Mental Disorders, 4th ed. criteria for BPD. We paired two control participants without a psychiatric history with each BPD patient according to age and sex. We compared the average lengths of follow-up, average doses of baclofen received, rates of heavy drinking days, rates of serious AEs, and rates of AEs resulting in baclofen withdrawal. Between BPD patients (n=23) and controls (n=46), there were no significant differences in mean age (45.3±11.2 vs. 45.2±11.2 years), sex ratio (43.5% women), mean duration of follow-up (8.0±4.0 vs. 7.7±4.2 months; P=0.77), and average daily dose of baclofen (102.2±42.7 vs. 94.6±9.7 mg/day; P=0.44). However, the mean rate of heavy drinking days (74.3±25.3 vs. 41.7±33.3%; P<10E−4), the rate of serious AEs (65.2 vs. 6.5%; P<10E−4), and the rate of treatment discontinuation after AEs (52.2 vs. 8.6%; P<10E−4) were significantly higher in BPD. The benefit/risk balance of HDB appears to be unfavorable in comorbid BPD patients compared with nonpsychiatric patients.

aCAMTEA, Supervised Off-label Prescribing System in Addiction Medicine

Departments of bAddiction Medicine

cBiostatistics

dPharmacovigilance

eCSAPA, CHU Lille

Departments of fPharmacology, EA 1046

gNeurosciences, LNFP, EA 4559, Univ Lille Nord de France, Lille

hDepartment of Adult Psychiatry, CH Douai, Douai, France

Correspondence to Benjamin Rolland, MD, PhD, Service d’Addictologie, CHU Lille, Hôpital Fontan2, Rue André Verhaeghe, CS 70001, 59037 Lille Cedex, France Tel: +33 320 445 838; fax: +33 3 20 44 57 78; e-mail: benjamin.rolland@chru-lille.fr

Received August 8, 2014

Accepted September 24, 2014

© 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins