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EPA-1464 – Alcoholism: Personalized Medicine or Stratified Medicine?

Published online by Cambridge University Press:  15 April 2020

K. Mann
K. Mann*
Affiliation:
University of Heidelberg, Central Institute of Mental Health, Mannheim, Germany

Abstract

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Personalised approaches have a long history in the treatment of alcoholism. ‘Matching treatments to patient's heterogeneity’ was the codeword for these attempts. Large studies failed to show a matching effect, maybe because they only took behaviour and psychophathology as basis for matching. More recent studies included biological variables for stratification of patients. Genetics, neuroimaging and psychopathology showed very promising results. Examples of the PREDICT study (Mann et al., 2013) will be given.

424 patients were randomised to either placebo, naltrexone or acamprosate. Using neuroimaging we confirmed that an increase in brain activity in the ventral striatum is related to time to relapse. We also found support for our hypothesis concerning the rewarding characteristics of alcohol in a certain subgroup of patients. Here f-MRI BOLD response in the ventral striatum predicted a positive naltrexone response. Finally a psychometric test distinguished between ‘reward cravers’ and ‘relief cravers’ (Glöckner-Rist et al., 2013).The former respond significantly better to pharmacotherapy.

In conclusion the treatment of alcoholism is moving towards a personalised approach. This holds the potential for a significant increase in effect sizes of our treatment trials and thus for better treatment options for our patients.

Type
S535 - Improving pharmacological treatments: Personalized Medicine or Stratified Medicine?
Information
European Psychiatry , Volume 29 , Issue S1: Abstracts of the 22nd European Congress of Psychiatry , 2014 , pp. 1
Copyright
Copyright © European Psychiatric Association 2014

References

Mann, K., T. et al. Results of a double-blind, placebo-controlled pharmacotherapy trial in alcoholism conducted in Germany and comparison with the US COMBINE study. Addict Biol, 2013, epub ahead of print.Google Scholar
Glockner-Rist, A.Lemenager, T.Mann, K.Reward and relief craving tendencies in patients with alcohol use disorders: Results from the PREDICT study. Addict Behav 2013; 38: 1532–1540CrossRefGoogle ScholarPubMed
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