Alcohol Use Disorder Pharmacotherapy May Improve Liver-Related Outcomes

New research is shedding light on a potential association between alcohol use disorder (AUD) pharmacotherapy and improved hepatic outcomes in patients with alcohol-related liver disease (ALD).1

The scoping review included 3 retrospective cohort studies conducted in North America with more than 45,000 participants, 5% of whom received AUD treatment. In 2 out of 3 studies, receipt of AUD pharmacotherapy was associated with decreased hepatic decompensation and mortality.1

According to the data from the World Health Organization on global alcohol consumption, an estimated 400 million people ≥15 years of age were living with alcohol use disorders in 2019. Alcohol consumption is causally linked to more than 200 health conditions, including at least 30 that would not exist without alcohol consumption, one being ALD.2,3

“Despite the proven efficacy of pharmacotherapy in treating AUD, medications for AUD remain underutilized in patients with less than 10% of patients receiving pharmacotherapy,” Jennifer Flemming, MD, an associate professor of medicine and public health sciences at Queen's University, and colleagues wrote.1 “While it is known that medications for AUD improve abstinence rates in patients with ALD, the literature on whether these therapies affect liver-related outcomes remains limited.”

To address this gap in research, investigators conducted a scoping review using articles found through an electronic search of EMBASE, MEDLINE, EBM Reviews–Cochrane Central Register of Controlled Trials, and EBM Reviews–Cochrane Database of Systematic Reviews databases. Search results were initially screened by individually assessing the titles and abstracts to identify full-text articles exploring pharmacotherapy for AUD and impacts on patients with ALD.1

The primary outcome of the present study was liver outcomes after receiving pharmacotherapy for AUD, including decompensated cirrhosis, mortality, progression of ALD, and need for liver transplantation.1

A total of 2521 studies were screened, of which 3 retrospective cohort studies conducted in North America were selected for inclusion in the present analysis. These studies enrolled a total of 45,948 patients, 98% of whom were male with a mean age of 58.7 years.1

Investigators noted all studies explored acamprosate and naltrexone, 2 studies explored disulfiram, and 1 study explored gabapentin, topiramate, baclofen.1

Among the cohort, a total of 43,649 (95%) patients did not receive any AUD treatment, while 2299 (5%) received pharmacological treatment.1

Of the 2 studies that reported data on psychiatric comorbidities and substance use disorders, psychiatric comorbidities were present in 42% of the non pharmacotherapy group and 60% of the pharmacotherapy group. Additionally, investigators pointed out concomitant substance use disorders were present in 46% of the non pharmacotherapy group and 71% of the pharmacotherapy group.1

Hepatic decompensation was reported as an outcome in 2 out of 3 studies, one of which did not provide details regarding how the outcome was defined. In this study, patients were followed for a mean duration of 7.8 years in the treated group and 8.6 years in the untreated group. Results showed receiving pharmacotherapy for AUD was associated with a reduced incidence of hepatic decompensation (adjusted odds ratio [AOR], 0.35) and a longer time to first hepatic decompensation after cirrhosis diagnosis (6.3 years vs 2 years).1

In the other study, hepatic decompensation was defined as variceal bleeding; hepatic encephalopathy; hepatopulmonary syndrome; ascites; spontaneous bacterial peritonitis; or hepatorenal syndrome based on ICD-9-CM codes. Results showed receipt of any type of AUD therapy was associated with significantly decreased odds of hepatic decompensation (AOR, 0.63).1

Death was reported as an outcome in 2 out of 3 studies. One of these studies found that use of pharmacotherapy for AUD in the first year after cirrhosis diagnosis was associated with a 20% reduced hazard of all-cause mortality, and longer duration of exposure to pharmacotherapy was associated with improved survival. Similarly, the other study found that any therapy for AUD, including pharmacotherapy and/or behavioural therapy, was associated with decreased mortality at 180-day-follow up (AOR, 0.87).1

Of note, investigators did not find any studies that looked at transplant or liver disease progression as an outcome.1

“Our scoping review demonstrates there are limited studies exploring the association between AUD pharmacotherapy and ALD,” investigators concluded.1 “Despite the significance of pharmacotherapy in treating AUD there remains a substantial gap in research within this area. Moving forward, further prospective studies need to be completed studying this association.”

References

1. Jogendran M, Huynh L, Flemming JA. Alcohol Use Disorder Pharmacotherapy in Patients With Alcohol-Related Liver Disease: A Scoping Review. Canadian Journal of Gastroenterology and Hepatology. https://doi.org/10.1155/cjgh/6455092

2. World Health Organization. Alcohol. June 28, 2024. Accessed April 7, 2025. https://www.who.int/news-room/fact-sheets/detail/alcohol

3. World Health Organization. Alcohol Use. August 21, 2024. Accessed April 7, 2025. https://www.who.int/europe/news-room/fact-sheets/item/alcohol-use