Bankole A Johnson from the University of Texas Health Science Center at San Antonio, USA, and colleagues randomly allocated 150 heavy drinkers (defined as 5 alcoholic drinks per day for men, four for women) to receive either topiramate or placebo for three months in addition to standard behaviour therapy.
People in the group receiving topiramate were drinking around three fewer drinks per day than those in the placebo group after three months follow-up. Topiramate therapy resulted in around a quarter fewer heavy drinking days and a quarter more abstinence days compared with those given placebo. Plasma concentrations of the enzyme g-glutamyl transferase-an objective measure of high alcohol consumption-were substantially reduced for people given topiramate.
Bankole A Johnson comments: "Topiramate is a new weapon in our armamentarium for treating alcohol dependence. This proof-of-concept study opens up a new area of pharmacological discovery of effective treatments for alcohol dependence. As such, our knowledge on the basic science underpinnings of alcoholism is improved, and this should bring about hope for the identification of even more efficacious medications in the future." (Quote by e-mail; does not appear in published paper).
In an accompanying Commentary (p 1666), Robert Swift from Providence VA Medical Center, USA, states how Johnson and colleagues' study differs from previous research in this field as participants were not required to be abstaining from alcohol consumption at the start of the study. He concludes: "There remain many unanswered questions about topiramate, and about pharmacotherapies for alcoholism in general. These include: the optimum duration of treatment and drug doses; relative effectiveness between different populations and in different alcoholic subtypes, effectiveness when administered with different types of psychosocial therapies; and effectiveness of combinations of drugs. Research is underway to answer these questions and will provide clinicians and patients with improved treatments for this chronic disorder."
Contact: Will Sansom or Aileen Salinas, The University of Texas Health Science Center at San Antonio External Affairs Office;
T) +1 210 567 2570;
E) sansom@uthscsa.edu
Dr Robert M Swift, Providence VA Medical Center, Providence, RI 02908, USA;
T)401-457-3066;
E) Robert_Swift@brown.edu
Journal
The Lancet