Meta-analysis of benzodiazepine use in the treatment of acute alcohol withdrawal

Objective: To analyse the evidence for the efficacy and potential harmful e ffects of benzodiazepines compared with other therapies in the treatment of acute alcohol withdrawal. Data sources: MEDLINE and the Cochrane Controlled Trials Registry were sear ched for English-language articles published from 1966 to December 1997 tha t described randomized controlled trials (RCTs) of benzodiazepines in the t reatment of acute alcohol withdrawal. Key words included "benzodiazepines" (exploded) and "randomized controlled trial." Bibliographies of relevant ar ticles were reviewed for additional RCTs, and manufacturers of benzodiazepi nes were asked to submit additional RCT reports not in the literature. Study selection: Articles were considered for the meta-analysis if they wer e RCTs involving patients experiencing acute alcohol withdrawal and compari ng a benzodiazepine available in Canada with placebo or an active control d rug. Of the original 23 trials identified, 11 met these criteria, represent ing a total of 1286 patients. Data extraction: Data were extracted regarding the participants, the settin g, details of the intervention, the outcomes (including adverse effects) an d the methodologic quality of the studies. Data synthesis: The meta-analysis of benefit (therapeutic success within 2 days) showed that benzodiazepines were superior to placebo(common odds rati o [OR] 3.28, 95% confidence interval [CI] 1.30-8.28). Data on comparisons b etween benzodiazepines and other drugs, including P-blockers, carbamazepine and clonidine, could not be pooled, but none of the alternative drugs was found to be clearly more beneficial than the benzodiazepines. The meta-anal ysis of harm revealed no significant difference between benzodiazepines and alternative drugs in terms of adverse events (common OR 0.67, 95% CI 0.34- 1.32) or dropout rates (common OR 0.68, 95% CI 0.47-0.97). Interpretation: Benzodiazepines should remain the drugs of choice for the t reatment of acute alcohol withdrawal.