Pharmacotherapy for alcohol use disorder ‘underutilized’ in at-risk populations
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Key takeaways:
- Pharmacotherapy appears to be underused in alcohol use disorder, especially among those with related liver disease.
- Just one in 50 patients with alcohol-associated liver disease received therapy.
PHILADELPHIA — Pharmacologic therapy for alcohol use disorder may be an “underutilized treatment modality,” especially in patients with related liver disease, according to research presented at the ACG Annual Scientific Meeting.
“Alcohol-associated liver disease, or ALD, is a common cause of cirrhosis and a leading indication for liver transplantation in the United States,” Alex R. Jones, MD, chief resident in the department of internal medicine at UT Southwestern Medical Center, told attendees. “The pharmacologic therapy of [alcohol use disorder (AUD)], specifically among patients with ALD, has previously been shown to reduce mortality and rates of hepatic decompensation.
“However, prior studies also suggest that pharmacologic therapy for AUD may be underutilized, and this is particularly pronounced among patients with ALD.”
To characterize the pharmacologic treatment of AUD among commercially insured U.S. adults, both with and without ALD, as well as factors associated with therapy and prescription patterns, Jones and colleagues used the PharMetrics Plus for Academics database to identify 28,625 individuals with AUD. Of those, 26,985 did not have ALD, 1,201 had ALD-related cirrhosis and 439 had acute alcohol-associated hepatitis (AAH).
According to results, patients who received pharmacotherapy were slightly older (median age, 45 years vs. 42 years), 64.5% were men, 45.9% had a psychiatric diagnosis other than AUD and 35.7% had a concomitant substance use disorder, in addition to AUD.
Pharmacologic therapy was prescribed to 14% patients without ALD, 2% with ALD cirrhosis and 10% with AAH, and one-time prescriptions without additional refills were given to 28.4%, 10.7% and 18.6%, respectively.
Notably, time to prescription “approached 1 year in all three cohorts, with no significant difference between these groups,” Jones said.
When evaluating individual medications, the researchers found that gabapentin was the most prescribed in all three cohorts, while baclofen was uncommonly prescribed, despite previous reports of its safety and efficacy.
“Oral naltrexone, which is a common FDA-approved medication for the treatment of AUD, was not commonly used among cohorts with liver disease, but a slightly higher proportion of patients with acute alcohol-associated hepatitis did receive this medication relative to those with cirrhosis,” Jones told attendees.
Further, multivariable analysis showed that older age (≥ 50 years), female sex, a Charlson Comorbidity Index of at least 3 and psychiatric comorbidity were associated with increased odds of receiving pharmacotherapy. Conversely, patients with ALD cirrhosis or hepatic decompensation were less likely to receive pharmacotherapy vs. those without liver disease.
“AUD pharmacotherapy appeared to be underutilized in a large cohort of commercially insured U.S. adults,” Jones said. “In particular, just one in 50 patients with ALD received pharmacotherapy in this cohort. We identified several clinical and demographic variables that predicted the receipt of pharmacotherapy, and identified a prolonged latency period approaching 1 year between diagnosis and initiation of pharmacologic treatment among those who did receive pharmacotherapy.”
He continued: “Taken together, these results suggest that pharmacotherapy may be an underutilized treatment modality for AUD, particularly among patients with liver disease, and providers caring for these patients should consider early initiation of this therapy in select cases.”
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Jones AR, et al. Pharmacologic therapy for alcohol use disorder is underutilized in alcohol-associated liver disease among commercially insured U.S. adults. Presented at: ACG Annual Scientific Meeting; Oct. 25-30, 2024; Philadelphia (hybrid meeting).
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