Baclofen versus lorazepam for alcohol withdrawal.

Sir,

Gulati et al.[1] compared the efficacy of baclofen and lorazepam in 66 patients during uncomplicated alcohol withdrawal. They used an open-label, randomized Controlled study design. We believe that the study design was vitiated by two issues. One was the use of fixed drug dosing in the baclofen arm versus flexible drug dosing in the lorazepam arm; this discriminated against baclofen. The other was the use of rescue zolpidem in the baclofen arm only; this discriminated against lorazepam. Generalizations about the relative efficacies of baclofen and lorazepam are therefore problematic.

We also note that while about 45% of baclofen patients were reported to require rescue lorazepam, the average number of occasions of use of rescue medication by each patient was not stated. Other matters of concern are that Table 1 in their paper provides information on only 45 out of the 66 patients and that ANOVA was used to compare “ordinal” variables; did the authors mean continuous variables?

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