Background and Aim: Alcohol-related liver disease (ARLD) is the most common cause of liver cirrhosis; despite the clear benefit of abstinence this remains challenging to achieve. Pharmacotherapeutic options for the treatment of alcohol use disorder (AUD) are available, however, these medications are only sporadically prescribed by hepatologists. This paper aims to establish the utility of specific AUD pharmacotherapies prescribed to patients with ARLD within our local population.

Methods: A retrospective intention-to-treat cohort study of AUD medication prescribed through the hepatology clinic or on discharge from the inpatient hepatology unit over the last 24 months was completed. The primary outcome was alcohol abstinence at 6 months +/- 2 months with a secondary outcome of reduced alcohol consumption at 6 months +/- 2 months. Each patient was prescribed either acamprosate, baclofen, gabapentin or naltrexone. Patients were additionally offered behavioural and psychological support either through referral to Alcohol and Other Drugs Service (AODS), hepatology nurse review through the hepatology alcohol reduction program or psychotherapy through the hepatology clinic psychologist. To calculate the absolute risk reduction with pharmacotherapy, the UKMAS study was utilised (Chick et al, 2000). The result from the UKMAS study showed in the placebo/psychotherapy group the abstinence rate was 11% and a reduction in a further 6% of patients.

Results: The cohort comprised 87 patients with 81% with cirrhosis (57% Child’s Pugh A). The mean age was 54 years. There were 40 males and 47 females. The primary outcome of abstinence was achieved in 21% of patients with 56% achieving the secondary outcome of reduced alcohol intake as outlined in Figure 1. The absolute risk reduction for all medications to achieve abstinence was 8.5% with the NNT=12. Notably, in the follow-up period many patients experienced adverse effects and ceased medication while six patients did not commence treatment.

Conclusion: Patients receiving AUD medication mostly reduce their alcohol consumption with a fifth of patients achieving abstinence. Whilst some patients ceased medications within the follow-up period, there was still an overall reduction in alcohol consumption within the group. Given this positive initial response to medication, addressing compliance and tolerability in the clinical setting is paramount to achieving success with these medications. Regular assessment and management of specific drug side effects as well as psychotherapy to optimise engagement should be combined with the initial prescription of AUD medications to achieve long-term alcohol reduction and abstinence.