Howdy folks. I've been lurking for a while, will be posting my story soon, but in the meantime....
There's an important study on the effectiveness of Topamirate for alcoholism just published in the Journal of the American Medical Association (JAMA) -- this is the origin of the recent mainstream press attention, NPR, etc. It was a large clinical study, properly designed and showing a strong effect, and published in one of the most prestigious medical journals. If your doctor has been reluctant to prescribe topa "off-label", or you've been reluctant to ask, this study might convince him. You can read or download the paper free, but it's rather technical. I'm a biological scientist (yes, this damn disease can get anyone), so I thought I'd parse it for the rest of y'all:
This study was done by the same researchers who did the earlier Lancet (2003) study. The main difference is the study size -- over twice as many participants -- and the attempt to test lower doses as well as the 300 mg they had used earlier (which didn't really work out for them, see below). There were also some minor changes in the selection criteria, the choice of variables to measure, and so forth.
Experimental design: 371 alcoholics who wanted to quit were enrolled. Half received topa, half a placebo, for 14 weeks. The topa schedule ramped up to 300 mg over the first five weeks for about half of the topa group, or leveled off at a lower dose for the rest. Participants kept a log of their drinks each day.
Results: Those taking topa reduced their percentage of heavy drinking days (5+ drinks for men, 4+ for women) from 82% prior to the study, to 44% of days (if you assume all those who dropped out before completing the study relapsed to heavy drinking), or ~25% (if you only count people who completed the study). Those taking placebo reduced their percentage of heavy drinking days from 82% to about 52%. So the placebo group had some success, but the topa group had significantly more. Several other measures were also significant -- the one that caught my eye was the fraction of participants that achieved 28 continuous days of abstinence, about three times as many for the topa group as the placebo group. Likewise about twice as many achieved 28 continuous days without a heavy drinking day. They didn't find a difference within the topa group according to the dosage that they were leveled off at. They might have just not had enough participants at the lower dosages. Hard to say, but it suggests that 300 mg may not be necessary for most people.
Side effects: 19% of the topa group dropped out before completing the study, probably due to side effects. These included paresthesia (tingling hands and feet) in 51%, taste perversion 23%, loss of appetite 21%, difficulty with attention/concentration 15%, itching 10%. Side effects increased with dosage.
Bottom line: Within this group of alcoholics who wanted to quit, topa helped them have more success than a placebo. It works, and this study proves it fairly convincingly. Whether it's worth the side effects, well, that's up to you....
peace,
lilnev
There's an important study on the effectiveness of Topamirate for alcoholism just published in the Journal of the American Medical Association (JAMA) -- this is the origin of the recent mainstream press attention, NPR, etc. It was a large clinical study, properly designed and showing a strong effect, and published in one of the most prestigious medical journals. If your doctor has been reluctant to prescribe topa "off-label", or you've been reluctant to ask, this study might convince him. You can read or download the paper free, but it's rather technical. I'm a biological scientist (yes, this damn disease can get anyone), so I thought I'd parse it for the rest of y'all:
This study was done by the same researchers who did the earlier Lancet (2003) study. The main difference is the study size -- over twice as many participants -- and the attempt to test lower doses as well as the 300 mg they had used earlier (which didn't really work out for them, see below). There were also some minor changes in the selection criteria, the choice of variables to measure, and so forth.
Experimental design: 371 alcoholics who wanted to quit were enrolled. Half received topa, half a placebo, for 14 weeks. The topa schedule ramped up to 300 mg over the first five weeks for about half of the topa group, or leveled off at a lower dose for the rest. Participants kept a log of their drinks each day.
Results: Those taking topa reduced their percentage of heavy drinking days (5+ drinks for men, 4+ for women) from 82% prior to the study, to 44% of days (if you assume all those who dropped out before completing the study relapsed to heavy drinking), or ~25% (if you only count people who completed the study). Those taking placebo reduced their percentage of heavy drinking days from 82% to about 52%. So the placebo group had some success, but the topa group had significantly more. Several other measures were also significant -- the one that caught my eye was the fraction of participants that achieved 28 continuous days of abstinence, about three times as many for the topa group as the placebo group. Likewise about twice as many achieved 28 continuous days without a heavy drinking day. They didn't find a difference within the topa group according to the dosage that they were leveled off at. They might have just not had enough participants at the lower dosages. Hard to say, but it suggests that 300 mg may not be necessary for most people.
Side effects: 19% of the topa group dropped out before completing the study, probably due to side effects. These included paresthesia (tingling hands and feet) in 51%, taste perversion 23%, loss of appetite 21%, difficulty with attention/concentration 15%, itching 10%. Side effects increased with dosage.
Bottom line: Within this group of alcoholics who wanted to quit, topa helped them have more success than a placebo. It works, and this study proves it fairly convincingly. Whether it's worth the side effects, well, that's up to you....
peace,
lilnev
uch: When you kick youreslf in the butt, all you get is a sore butt and a tired foot"
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