Treatment for alcohol use disorder linked to lower odds for mortality in patients with ALD
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Key takeaways:
- Patients who received treatment for alcohol use disorder after a hospital encounter for ALD had reduced mortality.
- Older age, higher index CCI score and cirrhosis were associated with increased mortality.
VANCOUVER, British Columbia — A diagnosis of and treatment for alcohol use disorder after a hospital encounter for alcohol-associated liver disease correlated with lower odds for mortality, according to a presenter here.
“In recent years, particularly in the United States, there has been an increased incidence of and mortality from alcohol-associated liver disease,” Elizabeth Harris, MD, a first-year GI fellow at Marshall University, said at the ACG Annual Scientific Meeting. “A number of studies have shown that many patients with alcohol-associated liver disease, or ALD, do not actually receive any treatment for their underlying alcohol use disorder.
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“It’s common clinical practice to just treat the decompensating events that occur with liver disease, but to neglect the underlying use disorder.”
To assess the association between alcohol use disorder (AUD) treatment and clinical outcomes in ALD, Harris and colleagues used the private insurance claims database Truven to identify 40,777 beneficiaries with an inpatient ALD encounter between January 2009 and June 2019. After excluding those who had previous exposure to medication, researchers matched 2,820 beneficiaries who received at least one medication for AUD after index admission (35.1% women) with 2,820 who did not receive a prescription (31.4% women).
Most patients (42%) were prescribed gabapentin, followed by naltrexone (14%), acamprosate (12%), baclofen (7%), disulfiram (5%) and topiramate (4%). Harris noted that 16% of beneficiaries received multiple medications.
Post-index encounter analysis showed that those who did not receive medication for AUD had higher likelihood of mortality compared with those who did receive medication (6.5% vs. 2.1%) while post-index encounter AUD (61% vs. 81%) and psychiatric disorders (53% vs. 75%) were higher among those in the treatment group.
Stratified by mortality, unadjusted analysis demonstrated that older age, higher index Charlson Comorbidity Index score, and diagnoses of cirrhosis and hepatic encephalopathy at the index encounter were associated with increased mortality, while a diagnosis of hepatitis was negatively associated with mortality.
In addition, a higher proportion of patients with no mortality had a diagnosis of alcohol abuse at the index encounter and had at least one AUD medication prescribed after the index encounter for ALD.
“Our findings suggest that patients with ALD may really benefit from recognition of their AUD as a medical problem that also needs medical treatment,” Harris concluded. “We feel that further studies are warranted to address whether instituting AUD treatment as part of the standard-of-care management of ALD can improve outcomes for this worsening health care problem.”
Perspective
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Shreya Sengupta, MD
The work by Harris and colleagues adds vital information to our understanding of the importance of treating alcohol use disorder (AUD) in patients with ALD.
One of the most severe consequences of AUD is ALD, and treatment of the underlying addiction is key for improving outcomes in patients with ALD. Previous studies have reported the importance of AUD treatment in protecting against the development and progression of ALD, as well as the importance of AUD treatment in reducing hepatic decompensation and all-cause mortality. There are published commentaries on the importance of integrating addiction medicine and hepatology given the interdependence of the course of AUD and ALD.
A shift toward co-management of these two disease processes is already occurring in the fields of addiction medicine and hepatology, and this study adds critical knowledge to the growing body of literature highlighting the importance of simultaneous treatment of AUD and ALD.
References
Leggio L, et al. JAMA Netw Open. 2022;doi:10.1001/jamanetworkopen.2022.13022.
Rogal S, et al. Hepatology. 2020;doi:10.1002/hep.31042.
Vannier AGL, et al. JAMA Netw Open. 2022;doi:10.1001/jamanetworkopen.2022.13014.
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Harris E, et al. Impact of pharmacologic treatment for alcohol use disorder on mortality in patients with alcohol-associated liver disease: Analysis from a United States insurance claims database. Presented at: ACG Annual Scientific Meeting; Oct. 20-25, 2023; Vancouver, British Columbia (hybrid meeting).
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