Grebla Regina, Kauf Teresa L, Lax Angela, Cook Erin E, Lin Yilu, Liu Jieruo, Liu Shuqian, O'Sullivan Amy K, Shi Lizheng, Shi Sherry, Sullivan Maria A, Swallow Elyse, Witkiewitz Katie, Drexler Karen
Alkermes, Inc., Waltham, Massachusetts, USA.
Analysis Group, Inc., Boston, Massachusetts, USA.
Am J Addict. 2025 Sep;34(5):536-546. doi: 10.1111/ajad.70036. Epub 2025 May 12.
Several medications for alcohol use disorder (MAUDs) are recommended to treat alcohol use disorder (AUD) in the Veterans Affairs (VA) guidelines. This study descriptively characterized treatment patterns and healthcare resource utilization (HCRU) among VA patients with AUD treated with VA-recommended MAUDs.
Veterans Health Administration data (VHA; 08/01/2013-11/30/2019) were used to identify 31,384 adults aged ≥18 years with AUD who initiated disulfiram (n = 2115), acamprosate (n = 3756), oral naltrexone (n = 25,082), or extended-release naltrexone (XR-NTX; n = 431) following AUD diagnosis. Study measures, stratified by medication received, included treatment adherence (proportion of days covered), discontinuation, and HCRU over 1 year.
Mean time to treatment discontinuation was high for all MAUDs but longest for XR-NTX (92 vs. 55-59 days; all p < .001). Relative to the year preceding AUD diagnosis, treatment with MAUDs was associated with fewer hospitalizations (XR-NTX: 0.48 vs. 0.42; oral naltrexone: 0.58 vs. 0.47; acamprosate: 0.67 vs. 0.60; disulfiram: 0.63 vs. 0.57) and more outpatient visits per patient (XR-NTX: 20.0 vs. 36.0; oral naltrexone: 19.0 vs. 30.0; acamprosate: 19.0 vs. 31.0; disulfiram: 17.0 vs. 29.0).
Among veterans with AUD, this descriptive analysis found that MAUD use was associated with reduced hospitalizations, and XR-NTX was associated with a longer treatment duration versus oral MAUDs.
This real-world study is among the first to describe clinical characteristics, treatment patterns, and HCRU in VHA patients who initiated MAUDs when all MAUDs were included in the VHA formulary.
退伍军人事务部（VA）指南推荐了几种用于治疗酒精使用障碍（AUD）的药物（MAUDs）。本研究对接受VA推荐的MAUDs治疗的VA AUD患者的治疗模式和医疗资源利用（HCRU）进行了描述性分析。
利用退伍军人健康管理局的数据（VHA；2013年8月1日至2019年11月30日），确定31384名年龄≥18岁的AUD成年患者，他们在AUD诊断后开始使用双硫仑（n = 2115）、阿坎酸（n = 3756）、口服纳曲酮（n = 25082）或长效纳曲酮（XR-NTX；n = 431）。根据所接受的药物进行分层的研究指标包括治疗依从性（覆盖天数比例）、停药情况以及1年内的HCRU。
所有MAUDs的平均治疗停药时间都很长，但XR-NTX最长（92天对55 - 59天；所有p <.001）。与AUD诊断前一年相比，MAUDs治疗与住院次数减少相关（XR-NTX：0.48对0.42；口服纳曲酮：0.58对0.47；阿坎酸：0.67对0.60；双硫仑：0.63对0.57），且每位患者的门诊就诊次数更多（XR-NTX：20.0对36.0；口服纳曲酮：19.0对30.0；阿坎酸：19.0对31.0；双硫仑：17.0对29.0）。
在患有AUD的退伍军人中，这项描述性分析发现使用MAUDs与住院次数减少相关，且与口服MAUDs相比，XR-NTX的治疗持续时间更长。
这项真实世界研究是首批描述当所有MAUDs都被纳入VHA处方集时开始使用MAUDs的VHA患者的临床特征、治疗模式和HCRU的研究之一。
