Patients with alcohol use disorder (AUD) who receive medical addiction therapy have a significantly lower risk of developing alcohol-associated liver disease (ALD), according to study results published in JAMA Network Open.
In addition to analyzing whether medical addiction therapy would have an effect on ALD risk in patients with AUD, researchers sought to determine whether medical addiction therapy was associated with reduced risk for hepatic decompensation in patients with alcohol-associated cirrhosis.
Researchers conducted a retrospective cohort study using data from the Mass General Brigham Biobank, which included 127,480 patients enrolled from inception in 2010 to August 17, 2021. ALD and AUD diagnoses were identified with the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision.
The analysis included patients who received at least 3 prescriptions for 1 of the following medications for AUD: disulfiram, acamprosate, naltrexone, gabapentin, baclofen, and topiramate. The participants were considered to be treated in each analysis if they had begun medical addiction therapy before the relevant outcome.
A total of 9635 patients with AUD were included (60.4% men; mean age, 54.8±16.5 years; 83.4% White). Among the patients with AUD, 1135 had ALD (11.8%) and 3906 (40.5%) received medical addiction therapy.
Receiving any pharmacotherapy for AUD was independently associated with a decreased incidence of ALD (adjusted odds ratio [aOR], 0.37; 95% CI, 0.31-0.43; P <.001), according to a multivariable analysis.
Receiving gabapentin (aOR, 0.36; 95% CI, 0.30-0.43; P <.001), topiramate (aOR, 0.47; 95% CI, 0.32-0.66; P <.001), baclofen (aOR, 0.57; 95% CI, 0.36-0.88; P =.01), and naltrexone (aOR, 0.67; 95% CI, 0.46-0.95; P =.03) was independently associated with reduced odds of ALD. Receiving treatment with disulfiram was not associated with an outcome, but acamprosate was associated with increased odds of being diagnosed with ALD (aOR, 2.59; 95% CI, 1.84-3.61; P <.001).
Multivariable analysis also showed that any pharmacotherapy for AUD was associated with a decreased incidence of a hepatic decompensating event (aOR, 0.35; 95% CI, 0.23-0.53; P <.001). Each year of medical addiction therapy was associated with a greater reduction in risk for hepatic decompensation (hazard ratio, 0.93; 95% CI, 0.88-0.99; P =.02).
Patients who received medical addiction therapy after being diagnosed with cirrhosis were less likely to have hepatic decompensation (aOR, 0.41; 95% CI, 0.23-0.71; P =.002).
Study limitations included unknown confounders and an underrepresentation of women and racial and ethnic minority groups. Also, adherence to AUD pharmacotherapy was difficult to assess.
“In the absence of contraindications to medical addiction therapy, clinicians may consider the use of this treatment for AUD as a means to prevent ALD,” the researchers wrote. “Prospective randomized clinical trials are warranted to conclusively assess the benefits of both FDA-approved and off-label AUD pharmacotherapy as prophylaxis and treatment for ALD.”
Vannier AGL, Shay JES, Fomin V, et al. Incidence and progression of alcohol-associated liver disease after medical therapy for alcohol use disorder. JAMA Netw Open. 2022;5(5):e2213014. doi:10.1001/jamanetworkopen.2022.13014