Medications for AUD effective in alcohol-associated liver disease

Medications used to treat alcohol use disorder (AUD) also work in patients with alcohol-associated liver disease (ALD), including cirrhosis, a study has found.

A team of investigators conducted a retrospective chart review of patients with ALD and AUD, identified by ICD-10 codes at a tertiary care liver transplant centre between January 2022 and December 2023. Those prescribed medications for AUD with ≥90 days of follow-up were included in the analysis.

The investigators assessed clinical characteristics, liver disease severity, and gastrointestinal (GI) or hepatology involvement. They used multivariable logistic regression to examine the association with outcomes, including adherence to medications for AUD, alcohol abstinence, and negative alcohol biomarkers.

Of the 165 eligible patients (mean age 46.3 years, 42 percent female, 87 percent White participants), 41 percent had cirrhosis, of whom 75 percent had Child-Pugh B/C. Forty-seven percent of patients had GI/hepatology involvement.

The most prescribed medication for AUD was acamprosate (52 percent), followed by naltrexone (40 percent). At 90 days, mortality was 11 percent, adherence 46 percent, abstinence 38 percent, and negative biomarkers 39 percent.

Higher MELD-Na scores correlated with adherence and abstinence. GI/hepatology-prescribed medications for AUC showed an independent association with negative biomarkers (odds ratio, 5.37, 95 percent confidence interval, 1.58‒18.32; p=0.007) and favourable associations with adherence and abstinence.

“Outcomes were similar across prescribing providers, supporting broader GI/hepatology engagement in initiating AUD treatment,” the investigators said.

“ALD is a major cause of liver-related morbidity and mortality, with alcohol abstinence remaining the cornerstone of management,” they said. “Pharmacologic therapies for AUD can support abstinence but remain underutilized in patients with ALD.”