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Home » Does Pioglitazone Lead to Reduced Alcohol Use?

Does Pioglitazone Lead to Reduced Alcohol Use?

July 1, 2022
Deepti Anbarasan, MD. and Nicholas Apping, MD
From The Carlat Addiction Treatment Report
Issue Links: Editorial Information | PDF of Issue

Nicholas Apping, MD, and Deepti Anbarasan. 

MD. Dr. Apping and Dr. Anbarasan, authors for this educational activity, have no relevant financial relationship(s) with ineligible companies to disclose.

REVIEW OF: Dieperink E et al, Am J Addict 2021;30(6):570–577

STUDY TYPE: Retrospective cohort study

Some preclinical data suggest that pioglitazone (Actos), a medication commonly prescribed for type 2 diabetes, might be helpful for the treatment of addictive disorders, including alcohol use disorder (AUD). The purported mechanism is peroxisome proliferator–activated receptor-gamma agonism, which sensitizes the body to the effects of insulin but also might decrease substance cravings. A recent study sought more information about this medication by using a retrospective chart review to see if pioglitazone was associated with decreased drinking.

The authors used the Veterans Administration (VA) electronic medical record to identify 49 men with type 2 diabetes who had an Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) score ≥3 prior to starting pioglitazone. The AUDIT-C is a three-question scale designed to identify unhealthy alcohol use, defined as a score ≥4 for men or ≥3 for women (Bradley KA et al, Alcohol Clin Exp Res 2007;31(7):1208–1217). The VA health care system mandates annual AUDIT-C scores on all patients, making it a convenient metric for researchers to follow over time.

The participants were predominantly White (81.6%) and had a mean age of 67 years. Three of the subjects met criteria for AUD. Pioglitazone doses were 30–45 mg, typical for type 2 diabetes treatment, and the medication was prescribed for an average of 78.5 months. The primary outcome was change in AUDIT-C score after starting pioglitazone.

The mean AUDIT-C score prior to starting pioglitazone was 3.98 (95% confidence interval [CI]: 3.51–4.44), which decreased to 2.89 (95% CI: 2.46–3.32) while on the medication. Though relatively modest, this absolute change of 1.09 was statistically significant (p = <0.001). Sub-analysis showed that the greatest reduction in alcohol intake occurred during the first 12–18 months of starting pioglitazone (p = 0.013), with relatively stable alcohol use thereafter. Limitations of the study include its retrospective nature, lack of a control group, and lack of diversity within the cohort.

CARLAT TAKE

This limited study found a small though statistically significant decrease in AUDIT-C scores in patients taking pioglitazone. While the findings are intriguing, the clinical significance of this finding remains to be seen. Therefore, large-scale randomized controlled trials are needed before pioglitazone can be recommended as an AUD treatment.

KEYWORDS medication
    Deepti Anbarasan, MD.

    Computer-Based Training for CBT for Women in Residential Treatments

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    Nicholas Apping, MD

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    www.thecarlatreport.com
    Issue Date: July 1, 2022
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    Table Of Contents
    Supervised Drug Consumption
    Addiction and Borderline Personality Disorder
    Should Prolonged Abstinence From Alcohol Be Required Before Liver Transplant?
    Does Pioglitazone Lead to Reduced Alcohol Use?
    E-Cigarettes and Relapse to Cigarette Smoking
    Learning Objectives, Personality Disorders and Addiction, CATR, July/August 2022
    CME Post-Test - Personality Disorders and Addiction, CATR, July/August 2022
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