Safety and drinking outcomes among patients with comorbid alcohol dependence and borderline personality disorder treated with high-dose baclofen

Abstract

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.

Baclofen for alcohol dependence: Relationships between baclofen and alcohol dosing and the occurrence of major sedation

“…For each patient-month, we determined whether the maximum subjective sedation score reported by the patient across the previous month was rated as 7 or higher. In this case, as has been previously defined elsewhere (Rolland et al, 2015), we concluded that an episode of major sedation (EMS) occurred during that patient-month. If the maximum subjective sedation score was below 7, we concluded that no EMS occurred during the patient-month (noEMS).…”

Elevated rate of alcohol consumption in borderline personality disorder patients in daily life

“…In an investigation of alcohol craving, Lane et al (2016), working from the same dataset as the present study, found that BPD individuals, compared to community comparisons, drank a similar number of drinks per drinking episode ( quantity) and had fewer drinking episodes ( frequency ) over three weeks of ambulatory assessment (AA; also referred to as ecological momentary assessment). Rolland et al (2015) found that BPD participants with comorbid alcohol dependence did not differ from participants with only alcohol dependence in average weekly Q-F prior to beginning an alcohol treatment program. Using a nationally representative sample, Maclean and French (2014) found that BPD was positively associated with Q-F indicators.…”

The dose-effect relationship of baclofen in alcohol dependence: A 1-year cohort study

“…Having more thorough arguments for a dose–effect relationship of baclofen in alcohol dependence is of high importance, because it is already known that baclofen does have a dose–effect relationship with respect to one of its main adverse effects, that is, sedation (Rolland, Labreuche, et al, ). Therefore, prescribing HDB will be justified in the future only if it has been demonstrated that the benefits of using high doses counterbalance the safety risks resulting from this use.…”