Course of Alcohol Dependence in Patients Undergoing Alcohol Detoxification with Topiramate: Naturalistic Study of a 1-year Follow Up

Abstract

ABSTRACT

Background: Alcohol dependence is a serious problem in the world, including in Thailand. Several studies have reported that topiramate is effective in reducing the rate of drinking relapse, but there has been no evidence for its appropriateness in Thai patients. Moreover, one study from Thailand has found no significant difference between topiramate and placebo regarding time to first heavy drinking.

Objective: the aim of this study was to determine whether treating alcohol dependence with topiramate could prolong the drinking-free period for those who had taken topiramate for 1 year.

Materials and methods: This is a retrospective descriptive study of alcohol-dependent inpatients receiving topiramate since discharge from the hospital and who were followed during the outpatient treatment for a period of 1 year. Our subjects were divided to three groups depending on the dosage of topiramate; low dose, intermediate dose, and high dose were defined as 75 mg, 100 mg, and 150-200 mg per day, respectively. Data was collected and it consisted of demographic, inpatient treatment, and outpatient treatment data. The demographic data was analyzed in terms of mean and percentage and the treatment data was analyzed using the Kaplan-Meier survival curve for survival analysis. The analysis of the association between the three groups employed the Wilcoxon test.

Results: There were a total of 57 patients included in the study, but the number of admissions was 75. The mean duration of alcohol dependence was 23.3 years. Most patients (71.9%) received 100 mg of topiramate per day when discharged. At the end of the 1-year follow-up, 6 of 7 patients in the low-dose group relapsed to alcohol drinking (85.7%), while that number was 19 of 41 (46.3%) and 5 of 9 patients (55.6%) in the intermediate-dose group and the high-dose group, respectively. The relapse rates of alcohol dependent drinking were 71.4%, 31.7%, and 44.4% in the low-dose, intermediate-dose and high-dose group accordingly. The intermediate-dose patients had the longest relapse-free period; 8 months on average. The low-dose and high-dose groups averaged 5-month and 4-month relapse-free periods, respectively.

Conclusions: Topiramate, as an adjunct to psychosocial treatment, assisted in achieving relapse-free periods averaging 4-8 months. However, this study had some limitations, so further study is recommended.