Prazosin and cyproheptadine in combination in the treatment of alcohol use disorder: A randomized, double-blind, placebo-controlled trial

BACKGROUND AND AIMS

Pre-clinical studies suggest that the simultaneous blockade of the α1b and 5HT2A receptors may be effective in reducing alcohol consumption. This study aimed to assess the efficacy and safety of prazosin (α1b blocker) and cyproheptadine (5HT2A blocker) combination in decreasing total alcohol consumption (TAC) in alcohol use disorder (AUD).

DESIGN, SETTING AND PARTICIPANTS

This was a double-blind, parallel group, placebo-controlled, Phase 2, randomized clinical trial conducted in 32 addiction treatment centres in France. A total of 108 men and 46 women with severe AUD took part.

INTERVENTION

Participants were randomly assigned to one of the following 3-month treatments: (1) low-dose group (LDG) receiving 8 mg cyproheptadine and 5 mg prazosin extended-release (ER) formulation daily; (2) high-dose group (HDG) receiving 12 mg cyproheptadine and 10 mg prazosin ER daily; and (3) placebo group (PG) receiving placebo of cyproheptadine and prazosin ER. A total of 154 patients were randomized: 54 in the PG, 54 in the LDG and 46 in the HDG.

MEASUREMENTS

The primary outcome was TAC change from baseline to month 3.

FINDINGS

A significant main treatment effect in the change in TAC was found in the intent-to-treat population (P = 0.039). The HDG and LDG showed a benefit in the change in TAC from baseline to month 3 compared with PG: -23.6 g/day, P = 0.016, Cohen's d = -0.44; -18.4 g/day, P = 0.048 (Bonferroni correction P < 0.025), Cohen's d = -0.36. In a subgroup of very high-risk drinking-level participants (> 100 g/day of pure alcohol for men and > 60 g/day for women), the difference between the HDG and the PG in the primary outcome was -29.8 g/day (P = 0.031, Cohen's d = -0.51). The high and low doses were well-tolerated with a similar safety profile.

CONCLUSIONS

A randomized controlled trial of treatment of severe alcohol use disorder with a cyproheptadine-prazosin combination for 3 months reduced drinking by more than 23 g per day compared with placebo. A higher dose combination was associated with a larger magnitude of drinking reduction than a lower dose combination while showing similar safety profile.

World addiction medicine reports: formation of the International Society of Addiction Medicine Global Expert Network (ISAM-GEN) and its global surveys

Addiction medicine is a dynamic field that encompasses clinical practice and research in the context of societal, economic, and cultural factors at the local, national, regional, and global levels. This field has evolved profoundly during the past decades in terms of scopes and activities with the contribution of addiction medicine scientists and professionals globally. The dynamic nature of drug addiction at the global level has resulted in a crucial need for developing an international collaborative network of addiction societies, treatment programs and experts to monitor emerging national, regional, and global concerns. This protocol paper presents methodological details of running longitudinal surveys at national, regional, and global levels through the Global Expert Network of the International Society of Addiction Medicine (ISAM-GEN). The initial formation of the network with a recruitment phase and a round of snowball sampling provided 354 experts from 78 countries across the globe. In addition, 43 national/regional addiction societies/associations are also included in the database. The surveys will be developed by global experts in addiction medicine on treatment services, service coverage, co-occurring disorders, treatment standards and barriers, emerging addictions and/or dynamic changes in treatment needs worldwide. Survey participants in categories of (1) addiction societies/associations, (2) addiction treatment programs, (3) addiction experts/clinicians and (4) related stakeholders will respond to these global longitudinal surveys. The results will be analyzed and cross-examined with available data and peer-reviewed for publication.

Empathy of dental students and educators in French hospitals: A cross-sectional study

Empathy is a key factor in the dentist-patient relationship. The aim of this study was to determine empathy in dental students and educators in French hospital dental services. A cross-sectional study was conducted among dental students and educators who practiced in 10 hospital dental services affiliated with the Faculty of Dentistry of the University of Lorraine in France. A questionnaire was self-administered online using the Jefferson Scale of Physician Empathy (JSPE). The study included 209 participants comprising 50 students in fourth year, 66 students in fifth year, 48 students in sixth year, and 45 educators. Participants were 63.6% females, aged 27 ± 8 years. The mean empathy score was 109.40 ± 11.65. The sub-scores of the three dimensions were 57.02 ± 6.64 for Perspective Taking, 42.56 ± 6.22 for Compassionate Care, and 9.78 ± 2.61 for Walking in the Patient's Shoes. Females showed significant higher empathy scores than males (111.36 vs. 105.84). The empathy score was correlated with age and insignificantly decreased during clinical training (from 110.06 in fourth year to 106.63 in sixth year). French dental students and educators showed high levels of empathy.

[Competency-based pedagogical approach: illustration applied to the care relationship]

The reform of health studies and the inclusion in the Bachelor-Master-Doctorate curriculum implies a new way of teaching, with an inverted pedagogical relationship between student and teacher. The competency-based approach contributes to the development of the student's professional and interpersonal skills, in the same way as the support provided by the nurse in the care relationship, particularly in therapeutic education, in order to promote patient autonomy.

[Thiamin and alcohol use disorder: A national survey of practice]

OBJECTIVE

The survey aimed to estimate, in the presence of alcohol use disorder, the frequency of systematic prescription of thiamine, the factors associated with it, and those related to the administration (oral, intravenous, intramuscular) when Wernicke's encephalopathy is suspected.

METHODS

A self-questionnaire available on Internet was sent by e-mail to doctors and nurses taking care patients with alcohol use disorder.

RESULTS

In all, 565 professionals responded. The systematic prescription frequency of thiamine was 84.8 %, addiction care centers and medical-psychological centers prescribed it 5 times less than in psychiatric hospitals (OR=0.2 IC [0.1-0.5] P<0.0001), and medicine/surgery/obstetrics (MSO) services 10 times more than psychiatric hospitals (OR=10.7 IC [2.5-45.3] P<0.0001). The prescription decreased with the exercise period, the interns prescribing it 10 times more systematically (OR=10.9 IC [3.6-32.9] P<0.0001). In the presence of symptoms related to Wernicke's encephalopathy, thiamine administration was mainly oral (67.1 %). Intravenous administration was used more by the MSO services (OR=18.3 IC [10.2-32.7] P<0.0001), while the intramuscular injection was used more in psychiatric hospitals (OR=4.6 IC [1.7-11.9] P=0.0353).

CONCLUSION

The prescription of thiamine is rather systematic. In contrast, intravenous administration is underused, in the presence of symptoms related to Wernicke's encephalopathy, in favor of oral administration, and the more specific use of the intramuscular injection in psychiatry.