Oldroyd Christopher, Wood Jonathan, Allison Michael
University of Cambridge, Cambridge, UK
Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
BMJ Open Gastroenterol. 2024 Dec 22;11(1):e001654. doi: 10.1136/bmjgast-2024-001654.
Preventing return to alcohol is of critical importance for patients with alcohol-related cirrhosis and/or alcohol-associated hepatitis. Acamprosate is a widely used treatment for alcohol use disorder (AUD). We assessed the impact of acamprosate prescription in patients with advanced liver disease on abstinence rates and clinical outcomes.
This was a retrospective case-control study. We reviewed data on all patients admitted to a large tertiary centre in the UK with alcohol-related cirrhosis and/or alcohol-associated hepatitis. We used propensity risk score matching to match patients prescribed acamprosate to controls. The primary outcome was repeat hospitalisation.
There were 451 patients who met the inclusion criteria of whom 55 patients were started on acamprosate during their admission. Before matching there were significant differences between the cohorts. Patients who received acamprosate were younger (median age 51 vs 57, p<0.005), more likely to have a purely alcohol-related admission (53% vs 24%, p<0.001), and more likely to suffer from a comorbid psychiatric diagnosis (42% vs 20%, p<0.001). On average patients who were started on acamprosate consumed more alcohol (median 155 units/week vs 80 units/week, p<0.001), were less likely to have a partner (35% vs 54%, p 0.006) and more likely to be unemployed (67% vs 44%, p<0.001). After matching for factors with significant differences between groups, we generated a cohort of 53 patients prescribed acamprosate and 53 matched controls. At 1 year there was a significantly higher rate of readmission (85% vs 57%, p<0.001) in the acamprosate group. There were no statistically significant differences in abstinence rates or mortality at 1 year.
Acamprosate prescription was associated with higher rates of readmission in patients with cirrhosis and/or alcohol-associated hepatitis. This may reflect a greater severity of AUD in those patients or might indicate the limited ability of acamprosate to alter the disease course in this population.
对于酒精性肝硬化和/或酒精性肝炎患者而言，防止复饮至关重要。阿坎酸是一种广泛用于治疗酒精使用障碍（AUD）的药物。我们评估了在晚期肝病患者中开具阿坎酸处方对戒酒率和临床结局的影响。
这是一项回顾性病例对照研究。我们查阅了英国一家大型三级中心收治的所有酒精性肝硬化和/或酒精性肝炎患者的数据。我们使用倾向风险评分匹配法将开具阿坎酸处方的患者与对照组进行匹配。主要结局是再次住院。
有451名患者符合纳入标准，其中55名患者在住院期间开始使用阿坎酸。匹配前，各队列之间存在显著差异。接受阿坎酸治疗的患者更年轻（中位年龄51岁对57岁，p<0.005），更有可能因单纯酒精相关原因入院（53%对24%，p<0.001），更有可能患有合并精神疾病诊断（42%对20%，p<0.001）。平均而言，开始使用阿坎酸的患者饮酒量更多（中位每周155单位对80单位，p<0.001），有伴侣的可能性更小（35%对54%，p=0.006），失业的可能性更大（67%对44%，p<0.001）。在对组间有显著差异的因素进行匹配后，我们生成了一个由53名开具阿坎酸处方的患者和53名匹配对照组组成的队列。1年后，阿坎酸组的再入院率显著更高（85%对57%，p<0.001）。1年时的戒酒率或死亡率无统计学显著差异。
在肝硬化和/或酒精性肝炎患者中，开具阿坎酸处方与更高的再入院率相关。这可能反映出这些患者中酒精使用障碍的严重程度更高，或者可能表明阿坎酸改变该人群疾病进程的能力有限。
