Comparison of Alcoholism Subtypes as Moderators of the Response to Sertraline Treatment

Abstract

Background A variety of typologies have been used to categorize alcoholism’s diverse manifestations. Although the most widely studied typologies are dichotomous ones based on genetic epidemiologic findings or using cluster analytic methods, recent efforts have utilized a single item or the onset of a diagnosis of alcohol dependence to subtype individuals based on the age of alcoholism onset. We compared three different methods to subtype alcoholics. Methods This secondary analysis used data from 134 alcohol-dependent participants in a placebo-controlled trial of sertraline (Kranzler et al. 2011). We compared cluster analysis to distinguish two risk/severity subtypes (Babor et al. 1992) with two age-of-onset subtypes (i.e., based on the age of onset of problem drinking or the age at which alcohol dependence criteria were first met). Results Each method yielded subgroups that differed significantly from one another on demographic and clinical measures. Although concordance was high between the two age-of-onset methods, it was poor between the age-of-onset methods and the cluster analysis-derived approach. All three subtyping approaches significantly moderated the effects of sertraline or placebo, but only in the L′L′ genotype group, as originally reported (Kranzler et al. 2011). In all cases, sertraline treatment was superior to placebo in later-onset individuals and inferior to placebo in the earlier-onset groups. Conclusions Because age-of-onset subtypes can be defined retrospectively on an individual basis, they may be more clinically useful than cluster-derived subtypes, which require group data. Because the two age-of-onset measures we examined appear to have comparable validity, a single item is easier to use as a measure of the age of onset of problem drinking.

Type A/Type B Alcoholism Predicts Differential Response to Topiramate in a Smoking Cessation Trial in Dually Diagnosed Men

“…Recent work comparing alcoholic typologies by Kranzler et al (2012) has suggested that early age at onset of alcoholism (e.g., <25 years old) may be an equally significant moderator of alcohol treatment response and easier to apply than cluster-derived typology groups. We conducted additional analyses comparing early age at onset in our sample, and although early age at onset was more common in the Type B group than Type A (56% vs. 44%), this was not a statistically significant difference, 2 (1) = 0.51, p = 48.…”

The Strong Star Multidisciplinary PTSD Research Consortium

“…Dr. Roache participated in weekly STRONG STAR teleconferences and in monthly calls with Dr. Kim del Carmen. In response to an EAB request to specify subject recruitment milestones, Dr. Roache identified two recent reports (Kranzler et al 2011a,b) of a study showing differential efficacy of sertraline in the treatment of primary alcohol dependence. Based upon these data, we were able to conduct a new power analysis which suggested the need for much smaller samples than previously proposed.…”

Pharmacological treatment options for alcohol use disorder

“…Another study showed that fluoxetine reduced craving but had no effect on drinking (127). It has been shown that sertraline is beneficial for Babor type B alcohol dependents (125,127). An experimental study found that sertraline reduced alcohol consumption in women with an SS/SL 5-HTTLPR genotype but was not useful in women with an LL 5-HTTLPR genotype (110).…”

“…While the first studies showed that the SSRI fluoxetine reduced craving and heavy drinking (124), a later placebo-controlled study demonstrated that in patients without depression, fluoxetine had no effect on drinking (125). Another study showed that fluoxetine reduced craving but had no effect on drinking (127).…”