Symptoms-Triggered Approach Reduces Relapse in Alcohol Withdrawal Syndrome

The study findings consolidate the evidence supporting the reduced requirement of benzodiazepines associated with adopting a symptoms-triggered approach.

Reduced alcohol dependence relapse among individuals with alcohol withdrawal syndrome (AWS) is associated with a symptoms-triggered approach to treatment, according to study results published in Alcohol.

Researchers conducted a nonrandomized, prospective, single-center, controlled trial that included all patients with AWS admitted to the Sultan Qaboos University Hospital in Muscat, Oman. The fixed-dose approach was initiated for patients admitted from October 2019 through September 2020 (n=150). The symptoms-triggered approach was instituted for patients admitted from November 2020 through October 2021 (n=50). The primary endpoints were total dose of benzodiazepines, hospital length of stay, and 90-day readmissions rate.

The fixed-dose group vs the symptoms-triggered group had more smokers (70.7% vs 55.1%; P =.05) and patients with chronic liver disease (35.3% vs 14.0%; P =.02), and fewer patients with epilepsy (8.7% vs 20.0%; P =.03). Additional clinical baseline characteristics and demographics disclosed no significant between-group differences.

There was a significantly higher 90-day readmission rate with the fixed-dose approach (hazard ratio [HR] 2.61; 95% CI, 1.18-6.84; P =.01). Using Kaplan-Meier survival analysis, the fixed-dose approach showed a significantly shorter duration to the first readmission (HR 2.30; 95% CI, 1.16-5.60; P =.02).

The use of a symptoms-triggered approach to treat alcohol withdrawal syndrome was associated with a lower 90-day readmission rate, prolonged period to the first readmission, and reduced total dose of benzodiazepines, but longer length of hospital stay.

A significantly lower dose of diazepam (40 mg vs 10 mg; P <.01) and a significantly higher dose of thiamine (800 mg vs 600 mg; P <.01) was needed in the symptoms-triggered approach group. The symptoms-triggered approach group showed a significantly increased hospital length of stay (3.9 days vs 2.2 days; P <.01).

No significant between-group differences in need for critical care (ICU or high dependency unit), seizure incidence, or death were observed.

Limitations of the study include a lack of randomization, imbalanced baseline characteristics, and the unexplored use of adjunctive therapies for treating AWS.

Study authors conclude, “The use of a symptoms-triggered approach to treat alcohol withdrawal syndrome was associated with a lower 90-day readmission rate, prolonged period to the first readmission, and reduced total dose of benzodiazepines, but longer length of hospital stay.” They found the symptoms-triggered approach to be “safe, cost-effective, and associated with reduced alcohol dependence relapse.”

References:

Al-Maqbali JS, Al Alawi AM, Al-Mamari Q, Al-Huraizi A, Al-Maqrashi N. Symptoms-triggered approach vs fixed-scheduled approach of benzodiazepines for management of alcohol withdrawal syndrome: nonrandomized controlled trial. Alcohol. Published online October 11, 2022. doi:10.1016/j.alcohol.2022.09.004