Medical Addiction Therapy for AUD Reduces Risk of ALD

Augustin G. L. Vannier, BA

The use of medical addiction treatments for patients with alcohol use disorder (AUD) could ultimately reduce the risk of developing alcohol-associated liver disease (ALD).

A team, led by Augustin G. L. Vannier, BA, Alcohol Liver Center, Massachusetts General Hospital, Harvard Medical School, determined whether medical addiction therapy was linked to an altered risk of developing ALD patients with AUD.

Limited Data

There is currently limited data regarding the use of medical addiction therapy for AUD in patients with ALD, outside of baclofen, which has been found to have a favorable safety profile and beneficial for this patient population in multiple studies.

There has also been recent studies showing patients with cirrhosis treated with US Food and Drug Administration (FDA) approved therapies for AUD were less likely to experience hepatic decompensation over a 6-12 month period.

In the retrospective cohort study, the investigators used data from the Mass General Brigham Biobank, a research initiative involving 127,480 between 2010-2021. There was a mean follow-up from AUD diagnosis of 9.2 years. The team identified 9635 patients with AUD, 5821 of which were male (60.4%).

The mean age was 54.8 years. There were 1135 (11.8%) patients with ALD and 3906 (40.5%) patients treated with medical addiction therapy.

The investigators used a multivariable analyses and found medical addiction therapy for AUD was linked to a decrease incidence of ALD (aOR, 0.37; 95% CI, 0.31-0.43; P < .001).

Medical addiction therapy was defined as the use of disulfiram, acamprosate, naltrexone, gabapentin, topiramate, or baclofen and patients were considered to be treated if they initiated medical addition therapy prior to the relevant outcome.

The investigators sought main outcomes of adjusted odds ratios (aOR) for the development of ALD and hepatic decompensation, which were calculated and adjusted for multiple risk factors.

Associations

The association was evident for several medications, including naltrexone (aOR, 0.67; 95% CI, 0.46-0.95; P = .03), gabapentin (aOR, 0.36; 95% CI, 0.30-0.43; P < .001), topiramate (aOR, 0.47; 95% CI, 0.32-0.66; P < .001), and baclofen (aOR, 0.57; 95% CI, 0.36-0.88; P = .01).

The investigators also found pharmacotherapy for AUD was associated with a lower incidence of hepatic decompensation in patients with cirrhosis (aOR, 0.35; 95% CI, 0.23-0.53, P < .001).

This was true for naltrexone (aOR, 0.27; 95% CI, 0.10-0.64; P = .005) and gabapentin (aOR, 0.36; 95% CI, 0.23-0.56; P < .001) and persisted even when medical addiction therapy was only initiated after the diagnosis of cirrhosis (aOR, 0.41; 95% CI, 0.23-0.71; P = .002).

“Results of this study showed that receipt of medical addiction therapy for AUD was associated with reduced incidence and progression of ALD,” the authors wrote. “The associations of individual pharmacotherapy with the outcomes of ALD and hepatic decompensation varied widely.”

A Growing Problem

ALD is among the most common complications of excessive alcohol use, representing a wide spectrum of conditions ranging from the relatively benign hepatic steatosis to cirrhosis and hepatocellular carcinoma. Severe alcohol-associated hepatitis is the most aggressive form of the disease with a 30% 3-month mortality rate.

There are also many fears regarding a sharp potential increase in alcohol-related disorders due to the increased expectation of alcohol use during the COVID-19 pandemic.

“It is, therefore, critical to prevent the development of ALD to limit the morbidity and mortality associated with excessive alcohol use,” the authors wrote.

The study, “Incidence and Progression of Alcohol-Associated Liver Disease After Medical Therapy for Alcohol Use Disorder,” was published online in JAMA Network Open.