Singal Ashwani K, Zhang Wanyu, Shetty Akshay, Patel Arpan, Mohammed Shaikhoon, Bhandari Prabha, Abdallah Mohamed, Vatsalya Vatsalya, Leggio Lorenzo, Kong Maiying
Division of Gastroenterology Hepatology Nutrition, University of Louisville School of Medicine, Louisville, Kentucky, USA.
UofL Health Jewish Hospital, Louisville, Kentucky, USA.
Hepatol Commun. 2025 Apr 30;9(5). doi: 10.1097/HC9.0000000000000686. eCollection 2025 May 1.
To examine alcohol use disorder (AUD) treatment in patients with alcohol-associated liver disease (ALD) on alcohol relapse and liver-related outcomes.
Twenty-five eligible studies on 93,899 (33,834 AUD intervention) patients with ALD were analyzed. Data presented as HR, with a 95% CI. Of 14 studies in patients with ALD outside the liver transplantation (LT) setting, pooled data from 7 randomized controlled trials (RCTs) showed that AUD treatment reduces alcohol relapse by 73% (HR: 0.27, 95% CI: 0.15-0.46) with any treatment and by 77% (HR: 0.23, 95% CI:0.14-0.39) with medications in 5 RCTs on 322 (186 intervention) patients. AUD treatment from observational studies was associated with reduced readmission (5 studies) by 48% and decompensation (2 studies) by 52%, but not patient mortality (3 studies). Data showed moderate to high heterogeneity, without publication bias. Analysis of 8 observational studies on LT recipients showed that AUD treatment reduced alcohol relapse in the post-LT period by 59%, with 58% and 60% reduction using integrated and nonintegrated models, respectively. AUD treatment among LT recipients was associated with a reduction in patient mortality by 56% in 3 observational studies, but not in 2 RCTs (HR: 0.82, 95% CI: 0.38-1.79). Pooled data were homogeneous in the analysis of alcohol relapse but showed moderate heterogeneity in analyzing patient mortality.
Available data on AUD treatment in patients with ALD improves abstinence and liver-related outcomes both outside and within LT settings. RCTs are needed to examine (a) medications in patients with ALD to examine the benefit of alcohol relapse and patient outcomes and (b) the benefit of integrated multidisciplinary treatment to manage the dual pathology (AUD and liver disease).
探讨酒精性肝病（ALD）患者酒精使用障碍（AUD）的治疗对酒精复饮及肝脏相关结局的影响。
对25项纳入93899例（33834例接受AUD干预）ALD患者的合格研究进行分析。数据以风险比（HR）及95%置信区间（CI）呈现。在14项针对非肝移植（LT）背景下ALD患者的研究中，7项随机对照试验（RCT）的汇总数据显示，任何治疗方式均可使AUD治疗使酒精复饮率降低73%（HR：0.27，95%CI：0.15 - 0.46），在5项涉及322例（186例接受干预）患者的RCT中，药物治疗可使酒精复饮率降低77%（HR：0.23，95%CI：0.14 - 0.39）。观察性研究显示，AUD治疗与再入院率降低（5项研究）48%及失代偿率降低（2项研究）52%相关，但与患者死亡率无关（3项研究）。数据显示存在中度至高度异质性，无发表偏倚。对8项关于LT受者的观察性研究分析显示，AUD治疗使LT术后酒精复饮率降低59%，采用综合模型和非综合模型分别降低58%和60%。在3项观察性研究中，LT受者接受AUD治疗使患者死亡率降低56%，但在2项RCT中未显示此效果（HR：0.82，95%CI：0.38 - 1.79）。在酒精复饮分析中汇总数据具有同质性，但在分析患者死亡率时显示中度异质性。
现有关于ALD患者AUD治疗的数据可改善LT背景内外的戒酒情况及肝脏相关结局。需要进行RCT以研究：（a）ALD患者使用药物以检验对酒精复饮及患者结局的益处；（b）综合多学科治疗对处理双重病理（AUD和肝病）的益处。
