Initial Experience With Nalmefene in Alcohol-Related Liver Disease: A Real-World Retrospective Study.

Background: Complete abstinence is the cornerstone of alcohol-related liver disease (ALD) management. However, many patients struggle to achieve or sustain abstinence, prompting growing interest in harm reduction strategies, particularly pharmacological interventions to reduce alcohol intake. Nalmefene, an opioid receptor modulator, has shown efficacy in reducing alcohol consumption among individuals with alcohol dependence. However, its effects on hepatic parameters in ALD have not been well studied in real-world settings.

Objective: To evaluate the efficacy and safety of nalmefene in patients with ALD, focusing on changes in alcohol consumption, liver function, and hepatic reserve capacity.

Methods: The present retrospective observational study included 21 patients with ALD who received nalmefene therapy at our institution between September 2019 and December 2023. Data on alcohol intake, liver function tests, hepatic reserve capacity, and alcohol use disorders identification test scores were collected at baseline and after 6 months of treatment. Adverse events were also recorded.

Results: Within 1 month of initiating nalmefene, significant reductions in heavy drinking days and total alcohol consumption were observed. These reductions were accompanied by improvements in liver function parameters. However, no statistically significant changes in hepatic reserve capacity were noted. Most adverse events were mild to moderate (Grade 1 or 2), and no serious adverse events occurred.

Conclusion: Nalmefene appears to be a safe and effective pharmacological option for reducing alcohol intake and improving liver function in patients with ALD. These findings support its use as part of a harm reduction approach for those unable to achieve complete abstinence.