Baclofen effective treatment option for AUD in cirrhosis and alcohol-associated hepatitis patients
A review in Alimentary Pharmacology and Therapeutics has included various interventions for treating alcohol use disorder (AUD) in patients with cirrhosis and alcohol-associated hepatitis. It provides an overview of the available evidence and can serve as a starting point for developing new interventions. Although baclofen is the only intervention with evidence of benefit from randomized controlled trials (RCTs) in patients with cirrhosis, nonrandomized studies indicate that pharmaceutical and non-pharmaceutical interventions can improve clinical outcomes, particularly in reducing the risk of hepatic decompensation. In addition to identifying effective therapies for this patient group, improving access to and the use of these interventions and considering patients' preferences is essential.
The lead author of Systematic Review: Interventions for alcohol use disorder in Patients with cirrhosis or alcohol-associated hepatitis is Christopher Oldroyd et al.
In patients with a history of alcohol-related cirrhosis and alcohol-associated hepatitis, one of the crucial factors determining the prognosis includes the use of alcohol. The primary purpose of the present study is to conduct a systematic review of interventions for alcohol use disorder specific to these patients using research databases that include randomized and nonrandomized studies. Abstinence, hepatic decompensation and mortality were the primary outcomes.
The key results of the study are:
- Twenty-three studies met the inclusion criteria.
- This includes six randomized trials and 17 nonrandomized studies of interventions.
- The total number of patients included was 104,298, aged 44 to 65, and 75% were male.
- The interventions included psychological therapy, pharmacological therapies, specialist clinics, patient education and low-alcohol drinks.
- The only intervention significantly impacting primary outcomes was Baclofen.
- Three nonrandomized studies reported reduced episodes of hepatic decompensation.
- This was in response to psychological therapy, pharmacotherapy, and treatment.
- A meta-analysis of nonrandomized studies examining psychological therapy impact revealed statistically non-significant improvements in abstinence and mortality in 4 studies, each with OR od 1.87 and 0.47, respectively.
They said Baclofen benefits cirrhosis patients and is the only intervention, the team recorded this finding.
They noted that nonrandomized studies also point to non-pharmaceutical interventions possibly improving clinical outcomes.
This is the first review examining interventions for AUD in specific patients.
Some essential strategies in this review were a comprehensive search strategy, clear inclusion criteria and robust methodology, following guidelines (Cochrane Collaboration guidelines), emphasising sensitivity over specificity, protocol under the advisory panel of patients, Patient involvement and unique insights.
The study's limitations were the low number of RCTs, high risk of bias and fewer patients.
Further reading:
Oldroyd C, Greenham O, Martin G, Allison M, Notley C. Systematic review: Interventions for alcohol use disorder in patients with cirrhosis or alcohol-associated hepatitis. Aliment Pharmacol Ther. 2023 Aug 21. doi: 10.1111/apt.17665. https://pubmed.ncbi.nlm.nih.gov/37602505/
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