Pharmacological therapies for alcohol use disorder reduce hepatic decompensation & mortality in alcohol-related liver disease: A GRADE evaluation through a meta-analysis.

Abstract

Background & objectives The role of behavioural therapies for alcohol use disorder (AUD) has been reported in patients with alcohol-related liver disease (ALD); however, that of pharmacological treatments is yet to be established. We conducted a systematic review and meta-analysis to study the use of these pharmacological interventions in ALD for liver-related and patient-important outcomes, including abstinence. Methods We conducted a systematic search of four major databases. Title and abstract screening, full-text review, risk of bias assessment, and data extraction were performed independently by two reviewers. Random-effects meta-analysis was used to calculate pooled effect estimates with 95 per cent confidence intervals (CI). The certainty of the evidence was assessed using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) tool and categorised as high, moderate, low, or very low. Results Altogether, eleven studies (1 RCT and 10 cohort studies) were included in the systematic review and eight studies in the meta-analyses. Meta-analysis of two cohort studies (44813 participants) showed significantly lower odds of all-cause mortality with the use of AUD pharmacotherapy with acceptable statistical heterogeneity [Odds Ratio (OR) 0.86; 95% CI 0.79-0.93; I2 = 0%]. Meta-analysis of one RCT and three cohort studies (303 participants) for the outcome of abstinence revealed a pooled proportion of 47.5 per cent (95% CI, 42.1-52.9; I2 = 11.7%). The certainty in estimates was very low. Interpretation & conclusions The present systematic review and meta-analysis suggest that pharmacological therapies in ALD may reduce overall mortality and the incidence of hepatic decompensation. However, given the very low certainty of evidence, these findings should be interpreted with caution and underscore the need for well-designed trials.