Naltrexone reduced mortality risk by 17% in decompensated alcohol-associated cirrhosis

Key takeaways:

• Naltrexone reduced all-cause mortality by 17% in decompensated alcohol-associated cirrhosis.
• The drug also reduced risk for acute kidney injury and spontaneous bacterial peritonitis.

SAN DIEGO — Patients with decompensated alcohol-associated cirrhosis and ascites taking naltrexone had lower risk for all-cause mortality and liver disease complications, including acute kidney injury and spontaneous bacterial peritonitis.

“There is a growing interest in using a dual approach in treating alcohol-related liver disease [ALD], with a focus on liver disease on one hand, and alcohol use disorder (AUD) on the other,” Vinay Jahagirdar, MD, from the Stravitz-Sanyal Institute for Liver Disease and Metabolic Health at Virginia Commonwealth University, told Healio. “However, there exists a gap in knowledge about the use of naltrexone, a medication used for the treatment of alcohol use disorder, in patients with decompensated alcohol-related liver disease.”

In a retrospective analysis of the TriNetX health care research network, Jahagirdar and colleagues identified 40,623 patients with ongoing alcohol use diagnosed with decompensated alcohol-associated cirrhosis and ascites; the researchers compiled 2,274 patients who were on naltrexone and 38,349 patients who were not on naltrexone or acamprosate.

To compare the outcomes of patients who received naltrexone against those who did not, patients were propensity score matched for age, sex, race and ethnicity, with 1,459 patients included in each group. The researchers assessed patient outcomes between 30 days and 5 years after they had started naltrexone or after the development of ascites.

According to data presented at The Liver Meeting, naltrexone use was associated with lower risk for mortality and complications of liver disease, including acute kidney injury (OR 0.68, 95% CI 0.57-0.81; P <.001) and spontaneous bacterial peritonitis (OR 0.57, 95% CI 0.45-0.71], P <.001).

“Patients on naltrexone had a 17% reduction in all-cause mortality compared to those not on naltrexone, along with a 30% lower incidence of acute kidney injury, 26% lower incidence of spontaneous bacterial peritonitis and 43% lower incidence of hepatocellular carcinoma,” Jahagirdar told Healio.

Approximately half of the patients in each cohort were hospitalized during the follow-up period, with a median of 10 admissions per patient in both groups (P =.992), regardless of whether they received naltrexone. Although one in 4 patients died, those treated with naltrexone exhibited 20% lower risk for death compared to those who were not (OR 0.82, 95% CI 0.72-0.94, P =.005).

The researchers also reported that naltrexone was linked to a lower risk for esophageal varices (OR 0.79, 95% CI 0.6-1.0, P=.050). However, naltrexone use did not alter development of new episodes of alcohol-associated hepatitis (OR= 0.91; 95%, CI 0.71, 1.18).

“The use of naltrexone in patients with decompensated ALD was associated with improved survival,” Jahagirdar said. “It was not associated with other major liver-related outcomes, suggesting that it can be safely used in this population.”
However, he noted that additional studies are “needed to verify these data prospectively.”