Treatment of alcohol use disorder in alcohol-associated liver disease: A meta-analysis.

Background: To examine alcohol use disorder (AUD) treatment in patients with alcohol-associated liver disease (ALD) on alcohol relapse and liver-related outcomes.

Methods and results: Twenty-five eligible studies on 93,899 (33,834 AUD intervention) patients with ALD were analyzed. Data presented as HR, with a 95% CI. Of 14 studies in patients with ALD outside the liver transplantation (LT) setting, pooled data from 7 randomized controlled trials (RCTs) showed that AUD treatment reduces alcohol relapse by 73% (HR: 0.27, 95% CI: 0.15-0.46) with any treatment and by 77% (HR: 0.23, 95% CI:0.14-0.39) with medications in 5 RCTs on 322 (186 intervention) patients. AUD treatment from observational studies was associated with reduced readmission (5 studies) by 48% and decompensation (2 studies) by 52%, but not patient mortality (3 studies). Data showed moderate to high heterogeneity, without publication bias. Analysis of 8 observational studies on LT recipients showed that AUD treatment reduced alcohol relapse in the post-LT period by 59%, with 58% and 60% reduction using integrated and nonintegrated models, respectively. AUD treatment among LT recipients was associated with a reduction in patient mortality by 56% in 3 observational studies, but not in 2 RCTs (HR: 0.82, 95% CI: 0.38-1.79). Pooled data were homogeneous in the analysis of alcohol relapse but showed moderate heterogeneity in analyzing patient mortality.

Conclusions: Available data on AUD treatment in patients with ALD improves abstinence and liver-related outcomes both outside and within LT settings. RCTs are needed to examine (a) medications in patients with ALD to examine the benefit of alcohol relapse and patient outcomes and (b) the benefit of integrated multidisciplinary treatment to manage the dual pathology (AUD and liver disease).