Medications for alcohol use disorder in alcohol-associated liver disease: The role of gastroenterologist and hepatologist in treatment and outcomes.

BACKGROUND

Alcohol-associated liver disease (ALD) is a major cause of liver-related morbidity and mortality, with alcohol abstinence remaining the cornerstone of management. Pharmacologic therapies for alcohol use disorder (AUD) can support abstinence but remain underutilized in patients with ALD. The impact of Gastroenterology (GI)/hepatology involvement on the use and outcomes of medications for alcohol use disorder (MAUD) remains understudied.

METHODS

We conducted a retrospective chart review of patients with ALD and AUD identified by ICD-10 codes at a tertiary care liver transplant center between January 2022 and December 2023. Patients prescribed MAUD with ≥ 90 days of follow-up were included. Clinical characteristics, liver disease severity, and GI/hepatology involvement were assessed. Outcomes included MAUD adherence, alcohol abstinence, and negative alcohol biomarkers. Multivariable logistic regression evaluated associations with outcomes.

RESULTS

Among 165 patients (mean age 46.3 ± 10.8 years; 42% female; 87% White), 41% had cirrhosis, of whom 75% had Child-Pugh B/C. GI/hepatology was involved in 47% of cases. Acamprosate (52%) and naltrexone (40%) were most prescribed. At 90 days, mortality was 11%, adherence 46%, abstinence 38%, and negative biomarkers 39%. Higher MELD-Na scores were associated with adherence and abstinence. GI/hepatology-prescribed MAUD was independently associated with negative biomarkers (OR 5.37, 95% CI 1.58-18.32, p = 0.007) and showed favorable associations with adherence and abstinence.

CONCLUSION

MAUD are effective in patients with ALD, including cirrhosis. Outcomes were similar across prescribing providers, supporting broader GI/hepatology engagement in initiating AUD treatment.