Evaluating the Long‐Term Benefits of Medications for Alcohol Use Disorder in Alcohol‐Associated Cirrhosis

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BACKGROUND AND AIMS: The effectiveness and safety of medications for alcohol use disorder (MAUD) in treating alcohol-associated cirrhosis have not been fully elucidated. This study aims to explore the clinical benefits and risks of MAUD in patients with alcohol-associated cirrhosis and persistent alcohol use. METHODS: This retrospective cohort study utilised anonymised electronic health records (EHRs) from the TriNetX platform to evaluate the impact of MAUD on mortality, alcohol abstinence rates, hepatocellular carcinoma, hepatic decompensation and healthcare utilisation in patients with alcohol-associated cirrhosis. RESULTS: This study evaluated 200 054 patients with alcohol-associated cirrhosis; after propensity score matching, 17 548 patients (8774 in each group) were analysed comparing those treated with MAUD to those without. At 3 years, patients treated with MAUD exhibited significantly lower mortality (21.6% vs. 29.3%, HR 0.731, 95% CI 0.688-0.776, p < 0.001), reduced hepatocellular carcinoma (2.6% vs. 3.3%, HR 0.794, p = 0.010) and fewer hospitalisations (16.7% vs. 24.8%, HR 0.635, p < 0.001). Subgroup analyses revealed that among 5083 patients treated with naltrexone, 3-year mortality was reduced (19.8% vs. 30.3%, HR 0.645, 95% CI 0.596-0.699, p < 0.001), hepatocellular carcinoma incidence was lower (2.6% vs. 3.3%, HR 0.790, p = 0.047) and hepatic decompensation decreased (18.4% vs. 21.1%, HR 0.843, p = 0.004). Among 4108 patients treated with acamprosate, 3-year mortality was reduced (22.6% vs. 29.0%, HR 0.799, 95% CI 0.733-0.871, p < 0.001) and hospitalisations and emergency department visits were significantly lower, though no reduction in hepatocellular carcinoma was observed. CONCLUSION: This study demonstrates the significant benefits of MAUD in patients with alcohol-associated cirrhosis, including reduced mortality, lower healthcare utilisation and improved alcohol abstinence rates, supporting its integration into standard care protocols.

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