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Pharmacotherapy for Alcohol Use Disorder Associated With Lower Odds of Liver Disease
In people with alcohol use disorder, medical addiction pharmacotherapy is linked with reduced incidence and progression of alcohol-associated liver disease, according to study findings published online in JAMA Network Open.
“The results of this cohort study show an association between receipt of medical addiction therapy and decreased likelihood of developing alcohol-associated liver disease in patients with alcohol use disorder and lower incidence of hepatic decompensating events in patients with cirrhosis,” wrote corresponding author Jay Luther, MD, of the Massachusetts General Hospital Alcohol Liver Center, and coauthors. “The association between use of individual pharmacotherapy and incidence or progression of alcohol-associated liver disease and hepatic decompensation varied widely.”
The retrospective study included 9635 patients with alcohol use disorder from the Mass General Brigham Biobank who were followed an average 9 years. Researchers investigated medical addiction treatment with both drugs approved by the Food and Drug Administration (FDA) for alcohol use disorder and those used off-label.
Among patients, medical addiction therapy was associated with decreased incidence of alcohol-associated liver disease. The adjusted odds ratio for development of liver disease in patients who received medication for alcohol use disorder was 0.37, according to the study. By medication, adjusted odds ratios for liver disease development were lowest for gabapentin (0.36), topiramate (0.47), and baclofen (0.57).
In patients with alcohol-associated cirrhosis, pharmacotherapy for alcohol use disorder was linked with lower incidence of hepatic decompensation; researchers reported a 0.35 adjusted odds ratio. Adjusted odds ratios were 0.27 for naltrexone and 0.36 for gabapentin.
Even when medical addiction therapy was initiated after cirrhosis was diagnosed, the association with decreased liver disease progression persisted, the study showed.
“In the absence of contraindications to medical addiction therapy, clinicians may consider the use of this treatment for alcohol use disorder as a means to prevent alcohol-associated liver disease,” researchers wrote. “Prospective randomized clinical trials are warranted to conclusively assess the benefits of both FDA-approved and off-label alcohol use disorder pharmacotherapy as prophylaxis and treatment for alcohol-associated liver disease.”
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