Drugs to treat alcohol use disorder improve outcomes and reduce the risk of death in patients with alcohol-related liver disease (ALD), according to results from a retrospective cohort study.It was announced in American College of Gastroenterology (ACG) 2023 Annual Scientific Meeting Results from a study in Vancouver, British Columbia, showed that patients diagnosed with alcohol use disorder and prescribed one or more medications to treat alcohol use disorder had lower mortality rates. 1
“In the United States, mortality rates from alcohol, particularly alcohol-related liver disease, have increased dramatically over the past 20 years. However, studies show that many patients with ALD do not receive treatment for the alcohol use disorder that underlies ALD. ”, the researchers wrote.
Treatment for alcohol use disorder varies depending on the individual needs of the affected patient, but the main goals of treatment are to stop alcohol use and improve quality of life. Detoxification, psychological counseling, support groups, and oral or injectable medications are common treatment options, but referral to an alcohol use disorder treatment specialist is recommended. 2
To assess the association between alcohol use disorder medications and clinical outcomes in patients with ALD, Elizabeth Harris, M.D., of the University of Kentucky Department of Internal Medicine, and colleagues collected electronic health record data for recipients of a nationwide commercial insurance claim. did. Medicare Supplemental Database indexed inpatient encounters related to her ALD from January 1, 2009 to June 30, 2019. Beneficiaries were divided into cohorts based on exposure to naltrexone, acamprosate, gabapentin, topiramate, disulfiram, or baclofen after the index encounter. .1
Beneficiary data were collected until June 2020, when there was a 30-day gap in enrollment, mortality, or available data after indexing. Investigators found that propensity-matched beneficiaries who were exposed to alcohol after indexing used impairing drugs at a 1:1 ratio. Unexposed beneficiaries based on age, Charlson Comorbidity Index (CCI) index, commercial insurance or Medicare payer, and index diagnosis of alcoholic cirrhosis, alcoholic hepatitis diagnosis, hepatic encephalopathy, and end-stage renal disease. . 1
According to data presented by Harris at ACG 2023, 40,777 beneficiaries with an ALD code were identified and 2,932 received treatment for at least one type of alcohol use disorder after the index hospitalization. They were matched with a control cohort of 2,932 people who did not receive the study. . Among participants treated for alcohol use disorder after onset, 42% received gabapentin, 14% received naltrexone, 12% received acamprosate, 7% received baclofen, 5% disulfiram, 4% topiramate, and 16% received treatment for alcohol use disorder. Received multiple medications1.
In unadjusted analyses, older age, increased CCI, advanced cirrhosis, decreased hepatitis, and increased hepatic encephalopathy were all associated with increased risk of death. The researchers noted a higher proportion of patients without mortality (71.16%) were diagnosed with alcohol abuse at the time of presentation compared to patients with mortality (52.11%). Additionally, being prescribed one or more alcohol use disorder medications was associated with a lower risk of death. 1
“This association suggests that patients with ALD would benefit from recognizing alcohol use disorder as a medical problem that also requires treatment. Introducing AUD treatment as part of standard care management of ALD. The researchers concluded that further research is needed to examine whether outcomes of this worsening medical problem can be improved.
1. Harris E, Rudy C, Aguilar H, Mangino A, et al. Effect of pharmacological treatment of alcohol use disorders on mortality in patients with alcohol-related liver disease: An analysis from a US insurance claims database. Paper presentation: ACG 2023 Annual Academic Conference. Vancouver, British Columbia, Canada. From October 20th to 25th, 2023.
2. Mayo Clinic. Alcohol use disorder. Diagnosis and treatment. May 18, 2022. Accessed October 23, 2023. https://www.mayoclinic.org/diseases-conditions/alcohol-use-disorder/diagnosis-treatment/drc-20369250