Alcohol Use Disorder Pharmacotherapy Associated with Improved Liver Disease Outcomes

Alcohol use disorder (AUD) pharmacotherapy is underutilized, despite evidence that it improves drinking outcomes. Evidence of the long-term health benefits of AUD pharmacotherapy has been lacking. This study leveraged a long-term cohort of patients with AUD to assess the association between receipt of AUD pharmacotherapy* and the risk of alcohol-associated liver disease (ALD).

• Of the 9635 patients with AUD (83% white) followed for a mean of 9.2 years, 1135 (12%) had diagnosis of ALD and 3906 (41%) were treated with AUD pharmacotherapy for a mean of 4.1 years.
• In multivariable analyses, receipt of any AUD pharmacotherapy was associated with a decreased incidence of ALD (adjusted odds ratio [aOR], 0.37).
  • Associations were strongest for gabapentin, topiramate, baclofen and naltrexone; they were insignificant for disulfiram.
  • Acamprosate was associated with an increased risk of ALD (aOR, 2.59).
  • The overall association of AUD pharmacotherapy and incident ALD was dose-dependent.
• Receipt of any AUD pharmacotherapy was associated with lower incidence of hepatic decompensation in patients with cirrhosis (aOR, 0.35). Associations were strongest for naltrexone, gabapentin, and topiramate; they were insignificant for baclofen, acamprosate, and disulfiram.

* Defined as ≥3 months of disulfiram, acamprosate, naltrexone, gabapentin, topiramate, or baclofen.

Comments: This single-site study provides novel observational evidence of the potential long-term medical benefits of AUD pharmacotherapy, including non-FDA approved medications (i.e., gabapentin, topiramate, and baclofen). The finding that acamprosate, which has no liver toxicity or metabolism, was associated with an increased risk of ALD likely results from higher-risk patients having been systematically chosen for acamprosate treatment. Comparative medication trials would be necessary to confirm the medical benefits and potential harms of specific AUD medications.

Joseph Merrill, MD, MPH

Reference: 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.