Medications for alcohol use disorder promote abstinence in alcohol-related cirrhosis: results from a systematic review and meta-analysis.
Journal
Hepatology (Baltimore, Md.)
ISSN: 1527-3350
Titre abrégé: Hepatology
Pays: United States
ID NLM: 8302946
Informations de publication
Date de publication:
25 Aug 2023
25 Aug 2023
Historique:
received:
09
05
2023
accepted:
28
07
2023
medline:
25
8
2023
pubmed:
25
8
2023
entrez:
25
8
2023
Statut:
aheadofprint
Résumé
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 & results: we performed a systematic review and meta-analysis according to PRISMA guidelines on the efficacy of MAUD in patients with cirrhosis. Search was conducted in PubMed, Embase and Scopus, including all studies until May 2022. Population was defined as patients with AUD and cirrhosis. Primary outcome was alcohol abstinence (AA). Safety was a secondary outcome. We performed a random-effects analysis and expressed the results as relative risk (RR) of alcohol consumption. Heterogeneity was measured by I2. Out of 4,095 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 clinical trials (RCT). Only RCTs were included in the meta-analysis. MAUD were associated with a reduced rate of alcohol consumption [RR = 0.68 (CI 0.48-0.97), P = 0.03], increasing AA 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. MAUD in patients with cirrhosis are effective in promoting AA and have a good safety profile. Larger studies on the effects of MAUD are needed, especially in patients with advanced liver disease.
Sections du résumé
BACKGROUND
BACKGROUND
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 & results: we performed a systematic review and meta-analysis according to PRISMA guidelines on the efficacy of MAUD in patients with cirrhosis. Search was conducted in PubMed, Embase and Scopus, including all studies until May 2022. Population was defined as patients with AUD and cirrhosis. Primary outcome was alcohol abstinence (AA). Safety was a secondary outcome. We performed a random-effects analysis and expressed the results as relative risk (RR) of alcohol consumption. Heterogeneity was measured by I2. Out of 4,095 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 clinical trials (RCT). Only RCTs were included in the meta-analysis. MAUD were associated with a reduced rate of alcohol consumption [RR = 0.68 (CI 0.48-0.97), P = 0.03], increasing AA 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
CONCLUSIONS
MAUD in patients with cirrhosis are effective in promoting AA and have a good safety profile. Larger studies on the effects of MAUD are needed, especially in patients with advanced liver disease.
Identifiants
pubmed: 37625154
doi: 10.1097/HEP.0000000000000570
pii: 01515467-990000000-00550
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © 2023 American Association for the Study of Liver Diseases.