Liver and Bile

Hepatology. 2024;79(2):368–79

Gratacós-Ginès J, Bruguera P, Pérez-Guasch M, López-Lazcano A, Borràs R, Hernández-Évole H, Pons-Cabrera MT, Lligoña A, Bataller R, Ginès P, López-Pelayo H, Pose E

Medications for alcohol use disorder promote abstinence in alcohol-associated cirrhosis: Results from a systematic review and meta-analysis

Background and aims: The role of medications for alcohol use disorder (MAUD) in patients with cirrhosis is not well established. Evidence on the efficacy and safety of these drugs in these patients is scarce.
Approach and results: The authors performed a systematic review and meta-analysis according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocol guidelines on the efficacy of MAUD in patients with cirrhosis. A search was conducted in PubMed, Embase, and Scopus, including all studies until May 2022. The population was defined as patients with AUD and cirrhosis. The primary outcome was alcohol abstinence. Safety was a secondary outcome. A random-effect analysis was performed and the results were expressed as relative risk of alcohol consumption. Heterogeneity was measured by I². Out of 4095 unique references, 8 studies on 4 different AUD treatments (baclofen [n = 6], metadoxine [n = 1], acamprosate [n = 1], and fecal microbiota transplant [n = 1]) in a total of 794 patients were included. Four were cohort studies, and 4 were randomized controlled trials (RCTs). Only RCTs were included in the meta-analysis. MAUD was associated with a reduced rate of alcohol consumption (relative risk = 0.68; 95% confidence interval: 0.48–0.97; p = 0.03), increasing alcohol abstinence by 32% compared to placebo or standard treatment, despite high heterogeneity (I² = 67%). Regarding safety, out of 165 serious adverse events in patients treated with MAUD, only 5 (3%) were possibly or probably related to study medications.

Conclusion: Medications for alcohol use disorder (MAUD) in patients with cirrhosis are effective in promoting alcohol abstinence and have a good safety profile. Larger studies on the effects of MAUD are needed, especially in patients with advanced liver disease.

E. Pose, Liver Unit, Hospital Clínic de Barcelona, Barcelona, Spain, E-Mail: epose@clinic.cat

DOI: 10.1097/hep.0000000000000570

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Liver and Bile

Adequate versus deep response to ursodeoxycholic acid in primary biliary cholangitis: To what extent and under what conditions is normal alkaline phosphatase level associated with complication-free survival gain?

Hepatology. 2024;79(1):39–48

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Liver and Bile

Lack of complete biochemical response in autoimmune hepatitis leads to adverse outcome: First report of the IAIHG retrospective registry

Hepatology. 2024;79(3):538–50