Association of acamprosate versus gabapentinoids with hospitalization and total mortality in alcohol use disorder

Abstract

Importance

Alcohol use disorder (AUD) significantly increases hospitalizations and death. US Food and Drug Administration (FDA)-approved medications for AUD are underutilized. Gabapentinoids are not FDA-approved for AUD but are frequently prescribed by physicians.

Objective

To examine the association of acamprosate and gabapentinoids on healthcare utilization and total mortality in patients with AUD.

Methods

Two propensity score (PS)-matched retrospective cohort studies.

Participants

Veterans diagnosed with AUD (years 2003–2021) initiating acamprosate or gabapentinoids in an AUD-related encounter and not on chronic opioid therapy (AUD-cohort). Another PS-cohort of veterans who were hospitalized for AUD diagnoses (AUD-admission cohort). Subgroup analysis included people with chronic obstructive lung diseases, opioid use, and age categories.

Main Outcomes

Co-primary outcomes were admission for alcohol withdrawal (AW-admission) and annual rate of acute care events. Secondary outcome was total mortality.

Results

We matched 16,072 pairs of acamprosate and gabapentinoid users in AUD-cohort. AW-admission occurred in 35.4% of the acamprosate users and 30.0% of the gabapentinoid users (odds ratio [OR]: 1.28, 95% confidence interval [95% CI]: 1.22–1.34). Annual rate of acute care events in acamprosate and gabapentinoid users were 1.84 and 1.64, respectively (coefficient of regression [β]: 0.20, 95% CI: 0.12–0.28). There was no difference in total mortality (hazard ratio: 0.96, 95% CI: 0.91–1.005). In subgroup analysis, acamprosate use was associated with less total mortality in subgroups of people using opioids and older than 60 years.

Conclusion

Gabapentinoids are associated with reduced AW-admission and lower annual rates of acute care events compared to acamprosate. Gabapentinoids may offer a viable alternative for AUD in carefully selected populations.