Medications for AUD appear beneficial in patients with cirrhosis

Patients with alcohol-induced cirrhosis may benefit from medications to treat alcohol use disorder (AUD), according to a recent study.

Researchers performed a systematic review and meta-analysis of studies published up to May 2022 to evaluate the efficacy of AUD medications in patients with cirrhosis. Studies were included if they involved patients who had both AUD and cirrhosis. Alcohol abstinence was the primary outcome, defined as the proportion of patients who continued to abstain from alcohol at the end of follow-up, with safety as a secondary outcome. The results were published Aug. 25 by Hepatology.

Eight studies involving four AUD treatments in 794 patients were included. Five hundred sixty-two patients (71%) had cirrhosis, and of these, 55% had decompensated disease, 30% had compensated cirrhosis, and 15% had unknown compensation status. Thirty-one percent of patients with cirrhosis also had a clinical diagnosis of alcoholic steatohepatitis. Of the eight included studies, four were cohort studies and four were randomized clinical trials (RCTs); the latter, which involved 343 patients, were included in the meta-analysis. Of the 343 patients, 136 achieved alcohol abstinence, 51.1% of those assigned to treatment and 25.5% assigned to control. A random-effects analysis found that medications for AUD were associated with lower alcohol consumption versus placebo or standard treatment (relative risk, 0.68 [95% CI, 0.48 to 0.97]; P=0.03), although heterogeneity was high. Of the 165 serious adverse events in patients who received AUD medications, five (3%) were considered possibly or probably related to study medications.

The researchers noted that individual data analysis was not possible and that evidence on this topic in general is scarce. “In conclusion, despite the shortness of information, the pharmacological therapy for AUD in patients with alcohol-related cirrhosis has shown to promote [alcohol abstinence] in this study, with a good safety profile,” they wrote. “Until more RCTs with hard endpoints and longer follow-up in patients with advanced liver disease are performed, the results of this study should encourage a wider use of [medications for] AUD in patients with cirrhosis.”