Pharmacotherapy to Prevent Alcohol Relapse in Alcohol-Associated Liver Disease.

IF 4.1 Q1 Medicine

Current Gastroenterology Reports Pub Date : 2025-11-19 DOI:10.1007/s11894-025-01026-x

Wei Zhang, Soo Young Hwang, Jay Luther

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引用次数: 0

Abstract

Purpose of review: Alcohol use disorder (AUD) drives alcohol-associated liver disease (ALD), and relapsing after abstinence remains a significant challenge before and after transplantation. This review summarizes evidence for pharmacotherapies in relapse prevention and their integration into ALD care.

Recent findings: Naltrexone and acamprosate reduce the relapse in the general AUD population, though data in ALD are limited. Baclofen is the only drug tested in randomized trials in cirrhosis, with early benefit but mixed results in later studies. Gabapentin and topiramate are promising off-label options. Emerging agents include glucagon-like peptide-1 (GLP-1) receptor agonists, psilocybin, and fibroblast growth factor-21 (FGF21) analogs, all showing early signals in reducing alcohol use. Despite guideline support, pharmacotherapy is underutilized in ALD due to lack of insight, stigma, provider inexperience, and fragmented care. Integrated programs across the disease spectrum demonstrate feasibility and may improve pharmacotherapy uptake. Pharmacotherapy is effective yet underused for relapse prevention in ALD. Integration with behavioral interventions and multidisciplinary care is essential to expand access, evaluate novel therapies, and improve patient outcomes.

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预防酒精相关性肝病酒精复发的药物治疗

回顾目的：酒精使用障碍（AUD）驱动酒精相关肝病（ALD），戒酒后复发仍然是移植前后的一个重大挑战。本文综述了药物治疗在预防复发及其与ALD治疗相结合方面的证据。最近的研究发现：纳曲酮和阿坎普罗酸降低了普通AUD人群的复发，尽管ALD的数据有限。巴氯芬是唯一在肝硬化随机试验中测试的药物，早期有好处，但在后来的研究中结果好坏参半。加巴喷丁和托吡酯是有希望的标签外选择。新出现的药物包括胰高血糖素样肽-1 （GLP-1）受体激动剂、裸盖菇素和成纤维细胞生长因子-21 （FGF21）类似物，它们都显示出减少酒精使用的早期信号。尽管指南支持，但由于缺乏洞察力、耻辱感、提供者缺乏经验和分散的护理，药物治疗在ALD中未得到充分利用。跨疾病谱的综合方案证明了可行性，并可能提高药物治疗的吸收。药物治疗在预防ALD复发方面是有效的，但尚未得到充分利用。结合行为干预和多学科护理对于扩大可及性、评估新疗法和改善患者预后至关重要。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Current Gastroenterology Reports Medicine-Gastroenterology

CiteScore

7.80

自引率

0.00%

发文量

期刊介绍： As the field of gastroenterology and hepatology rapidly evolves, the wealth of published literature can be overwhelming. The aim of the journal is to help readers stay abreast of such advances by offering authoritative, systematic reviews by leading experts. We accomplish this aim by appointing Section Editors who invite international experts to contribute review articles that highlight recent developments and important papers published in the past year. Major topics in gastroenterology are covered, including pediatric gastroenterology, neuromuscular disorders, infections, nutrition, and inflammatory bowel disease. These reviews provide clear, insightful summaries of expert perspectives relevant to clinical practice. An Editorial Board of internationally diverse members suggests topics of special interest to their country/region and ensures that topics are current and include emerging research. We also provide commentaries from well-known figures in the field.