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Phenobarbital compared to benzodiazepines in alcohol withdrawal treatment: A register-based cohort study of subsequent benzodiazepine use, alcohol recidivism and mortality

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Askgaard, Gro ; Hallas, Jesper ; Fink-Jensen, Anders ; Molander, Anna Camilla ; Madsen, Kenneth Grønkjær ; Pottegård, Anton. / Phenobarbital compared to benzodiazepines in alcohol withdrawal treatment : A register-based cohort study of subsequent benzodiazepine use, alcohol recidivism and mortality. In: Drug and Alcohol Dependence. 2016 ; Vol. 161. pp. 258-64.

Bibtex

@article{f6f3d84be7ba4cfca7ea7c6e25445644,
title = "Phenobarbital compared to benzodiazepines in alcohol withdrawal treatment: A register-based cohort study of subsequent benzodiazepine use, alcohol recidivism and mortality",
abstract = "BACKGROUND: Long-acting benzodiazepines such as chlordiazepoxide are recommended as first-line treatment for alcohol withdrawal. These drugs are known for their abuse liability and might increase alcohol consumption among problem drinkers. Phenobarbital could be an alternative treatment option, possibly with the drawback of a more pronounced acute toxicity. We evaluated if phenobarbital compared to chlordiazepoxide decreased the risk of subsequent use of benzodiazepines, alcohol recidivism and mortality.METHODS: The study was a register-based cohort study of patients admitted for alcohol withdrawal 1998-2013 and treated with either phenobarbital or chlordiazepoxide. Patients were followed for one year. We calculated hazard ratios (HR) for benzodiazepine use, alcohol recidivism and mortality associated with alcohol withdrawal treatment, while adjusting for confounders.RESULTS: A total of 1063 patients treated with chlordiazepoxide and 1365 patients treated with phenobarbital were included. After one year, the outcome rates per 100 person-years in the phenobarbital versus the chlordiazepoxide cohort were 9.20 vs. 5.13 for use of benzodiazepine, 37.9 vs. 37.9 for alcohol recidivism and 29 vs. 59 for mortality. Comparing phenobarbital to chlordiazepoxide treated, the HR of subsequent use of benzodiazepines was 1.56 (95%CI 1.05-2.30). Similarly, the HR for alcohol recidivism was 0.99 (95%CI 0.84-1.16). Lastly, the HR for 30-days and 1 year mortality was 0.25 (95%CI 0.08-0.78) and 0.51 (95%CI 0.31-0.86).CONCLUSION: There was no decreased risk of subsequent benzodiazepine use or alcohol recidivism in patients treated with phenobarbital compared to chlordiazepoxide. Phenobarbital treatment was associated with decreased mortality, which might be confounded by somatic comorbidity among patients receiving chlordiazepoxide.",
keywords = "Adult, Alcoholism, Benzodiazepines, Chlordiazepoxide, Cohort Studies, Ethanol, Female, GABA Modulators, Hospitalization, Humans, Length of Stay, Male, Middle Aged, Phenobarbital, Registries, Substance Withdrawal Syndrome, Treatment Outcome, Comparative Study, Journal Article",
author = "Gro Askgaard and Jesper Hallas and Anders Fink-Jensen and Molander, {Anna Camilla} and Madsen, {Kenneth Gr{\o}nkj{\ae}r} and Anton Potteg{\aa}rd",
note = "Copyright {\textcopyright} 2016 Elsevier Ireland Ltd. All rights reserved.",
year = "2016",
month = apr,
day = "1",
doi = "10.1016/j.drugalcdep.2016.02.016",
language = "English",
volume = "161",
pages = "258--64",
journal = "Drug and Alcohol Dependence",
issn = "0376-8716",
publisher = "Elsevier Ireland Ltd",

}

RIS

TY - JOUR

T1 - Phenobarbital compared to benzodiazepines in alcohol withdrawal treatment

T2 - A register-based cohort study of subsequent benzodiazepine use, alcohol recidivism and mortality

AU - Askgaard, Gro

AU - Hallas, Jesper

AU - Fink-Jensen, Anders

AU - Molander, Anna Camilla

AU - Madsen, Kenneth Grønkjær

AU - Pottegård, Anton

N1 - Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

PY - 2016/4/1

Y1 - 2016/4/1

N2 - BACKGROUND: Long-acting benzodiazepines such as chlordiazepoxide are recommended as first-line treatment for alcohol withdrawal. These drugs are known for their abuse liability and might increase alcohol consumption among problem drinkers. Phenobarbital could be an alternative treatment option, possibly with the drawback of a more pronounced acute toxicity. We evaluated if phenobarbital compared to chlordiazepoxide decreased the risk of subsequent use of benzodiazepines, alcohol recidivism and mortality.METHODS: The study was a register-based cohort study of patients admitted for alcohol withdrawal 1998-2013 and treated with either phenobarbital or chlordiazepoxide. Patients were followed for one year. We calculated hazard ratios (HR) for benzodiazepine use, alcohol recidivism and mortality associated with alcohol withdrawal treatment, while adjusting for confounders.RESULTS: A total of 1063 patients treated with chlordiazepoxide and 1365 patients treated with phenobarbital were included. After one year, the outcome rates per 100 person-years in the phenobarbital versus the chlordiazepoxide cohort were 9.20 vs. 5.13 for use of benzodiazepine, 37.9 vs. 37.9 for alcohol recidivism and 29 vs. 59 for mortality. Comparing phenobarbital to chlordiazepoxide treated, the HR of subsequent use of benzodiazepines was 1.56 (95%CI 1.05-2.30). Similarly, the HR for alcohol recidivism was 0.99 (95%CI 0.84-1.16). Lastly, the HR for 30-days and 1 year mortality was 0.25 (95%CI 0.08-0.78) and 0.51 (95%CI 0.31-0.86).CONCLUSION: There was no decreased risk of subsequent benzodiazepine use or alcohol recidivism in patients treated with phenobarbital compared to chlordiazepoxide. Phenobarbital treatment was associated with decreased mortality, which might be confounded by somatic comorbidity among patients receiving chlordiazepoxide.

AB - BACKGROUND: Long-acting benzodiazepines such as chlordiazepoxide are recommended as first-line treatment for alcohol withdrawal. These drugs are known for their abuse liability and might increase alcohol consumption among problem drinkers. Phenobarbital could be an alternative treatment option, possibly with the drawback of a more pronounced acute toxicity. We evaluated if phenobarbital compared to chlordiazepoxide decreased the risk of subsequent use of benzodiazepines, alcohol recidivism and mortality.METHODS: The study was a register-based cohort study of patients admitted for alcohol withdrawal 1998-2013 and treated with either phenobarbital or chlordiazepoxide. Patients were followed for one year. We calculated hazard ratios (HR) for benzodiazepine use, alcohol recidivism and mortality associated with alcohol withdrawal treatment, while adjusting for confounders.RESULTS: A total of 1063 patients treated with chlordiazepoxide and 1365 patients treated with phenobarbital were included. After one year, the outcome rates per 100 person-years in the phenobarbital versus the chlordiazepoxide cohort were 9.20 vs. 5.13 for use of benzodiazepine, 37.9 vs. 37.9 for alcohol recidivism and 29 vs. 59 for mortality. Comparing phenobarbital to chlordiazepoxide treated, the HR of subsequent use of benzodiazepines was 1.56 (95%CI 1.05-2.30). Similarly, the HR for alcohol recidivism was 0.99 (95%CI 0.84-1.16). Lastly, the HR for 30-days and 1 year mortality was 0.25 (95%CI 0.08-0.78) and 0.51 (95%CI 0.31-0.86).CONCLUSION: There was no decreased risk of subsequent benzodiazepine use or alcohol recidivism in patients treated with phenobarbital compared to chlordiazepoxide. Phenobarbital treatment was associated with decreased mortality, which might be confounded by somatic comorbidity among patients receiving chlordiazepoxide.

KW - Adult

KW - Alcoholism

KW - Benzodiazepines

KW - Chlordiazepoxide

KW - Cohort Studies

KW - Ethanol

KW - Female

KW - GABA Modulators

KW - Hospitalization

KW - Humans

KW - Length of Stay

KW - Male

KW - Middle Aged

KW - Phenobarbital

KW - Registries

KW - Substance Withdrawal Syndrome

KW - Treatment Outcome

KW - Comparative Study

KW - Journal Article

U2 - 10.1016/j.drugalcdep.2016.02.016

DO - 10.1016/j.drugalcdep.2016.02.016

M3 - Journal article

C2 - 26922279

VL - 161

SP - 258

EP - 264

JO - Drug and Alcohol Dependence

JF - Drug and Alcohol Dependence

SN - 0376-8716

ER -

ID: 52615498