Incidence and Progression of Alcohol-Associated Liver Disease After Medical Therapy for Alcohol Use DisorderImportance: Alcohol-associated liver disease (ALD) is one of the most devastating complications of alcohol use disorder (AUD), an increasingly prevalent condition. Medical addiction therapy for AUD may play a role in protecting against the development and progression of ALD. Objective: To ascertain whether medical addiction therapy was associated with an altered risk of developing ALD in patients with AUD. Design, Setting, and Participants: This retrospective cohort study used the Mass General Brigham Biobank, an ongoing research initiative that had recruited 127 480 patients between its start in 2010 and August 17, 2021, when data for the present study were retrieved. The mean follow-up duration from AUD diagnosis was 9.2 years. International Statistical Classification of Diseases and Related Health Problems, Tenth Revision diagnosis codes were used to identify ALD and AUD diagnoses. Exposures: Medical addiction therapy was defined as the documented use of disulfiram, acamprosate, naltrexone, gabapentin, topiramate, or baclofen. Patients were considered to be treated if they initiated medical addiction therapy before the relevant outcome. Main Outcomes and Measures: Adjusted odds ratios (aORs) for the development of ALD and hepatic decompensation were calculated and adjusted for multiple risk factors. Results: The cohort comprised 9635 patients with AUD, of whom 5821 were male individuals (60.4%), and the mean (SD) age was 54.8 (16.5) years. A total of 1135 patients (11.8%) had ALD and 3906 patients (40.5%) were treated with medical addiction therapy. In multivariable analyses, medical addiction therapy for AUD was associated with decreased incidence of ALD (aOR, 0.37; 95% CI, 0.31-0.43; P < .001). This association was evident for naltrexone (aOR, 0.67; 95% CI, 0.46-0.95; P = .03), gabapentin (aOR, 0.36; 95% CI, 0.30-0.43; P < .001), topiramate (aOR, 0.47; 95% CI, 0.32-0.66; P < .001), and baclofen (aOR, 0.57; 95% CI, 0.36-0.88; P = .01). In addition, pharmacotherapy for AUD was associated with lower incidence of hepatic decompensation in patients with cirrhosis (aOR, 0.35; 95% CI, 0.23-0.53, P < .001), including naltrexone (aOR, 0.27; 95% CI, 0.10-0.64; P = .005) and gabapentin (aOR, 0.36; 95% CI, 0.23-0.56; P < .001). This association persisted even when medical addiction therapy was initiated only after the diagnosis of cirrhosis (aOR, 0.41; 95% CI, 0.23-0.71; P = .002). Conclusions and Relevance: Results of this study showed that receipt of medical addiction therapy for AUD was associated with reduced incidence and progression of ALD. The associations of individual pharmacotherapy with the outcomes of ALD and hepatic decompensation varied widely.
Substance Use Disorder Is Associated With Alcohol-Associated Liver Disease in Patients With Alcohol Use DisorderBackground and AimsSubstance use disorder (SUD) commonly associates with alcohol use disorder (AUD), and certain substances have independently been shown to drive liver injury. In this work, we sought to determine if coexisting SUD in patients with AUD is associated with the presence of alcohol-associated liver disease (ALD).MethodsWe performed a cross-sectional analysis using the Mass General Brigham Biobank to identify patients based on International Classification of Diseases, Tenth Revision, codes. We performed multivariate analyses accounting for a wide range of demographic and clinical variables to evaluate the association between SUD and ALD. We subsequently used the same method to evaluate the association between SUD and hepatic decompensation.ResultsWe identified 2848 patients with a diagnosis of AUD; 9.0% of them had ALD, and 25.2% had a history of SUD. In multivariate analyses, patients with SUD were more frequently diagnosed with ALD than those without SUD (odds ratio [OR] = 1.95, P = .001). Furthermore, the number of concurrent SUDs was positively associated with the diagnosis of ALD (OR = 1.33, P < .001). Independent of the presence of other SUDs, opioid use disorder in patients with AUD was associated with ALD (OR = 1.902, P = .02). In subsequent analyses, we found that sedative use disorder was associated with hepatic decompensation (OR = 2.068, P = .03).ConclusionIn patients with AUD, SUD, and particularly opioid use disorder, was independently associated with the diagnosis of ALD. Substance use disorder (SUD) commonly associates with alcohol use disorder (AUD), and certain substances have independently been shown to drive liver injury. In this work, we sought to determine if coexisting SUD in patients with AUD is associated with the presence of alcohol-associated liver disease (ALD). We performed a cross-sectional analysis using the Mass General Brigham Biobank to identify patients based on International Classification of Diseases, Tenth Revision, codes. We performed multivariate analyses accounting for a wide range of demographic and clinical variables to evaluate the association between SUD and ALD. We subsequently used the same method to evaluate the association between SUD and hepatic decompensation. We identified 2848 patients with a diagnosis of AUD; 9.0% of them had ALD, and 25.2% had a history of SUD. In multivariate analyses, patients with SUD were more frequently diagnosed with ALD than those without SUD (odds ratio [OR] = 1.95, P = .001). Furthermore, the number of concurrent SUDs was positively associated with the diagnosis of ALD (OR = 1.33, P < .001). Independent of the presence of other SUDs, opioid use disorder in patients with AUD was associated with ALD (OR = 1.902, P = .02). In subsequent analyses, we found that sedative use disorder was associated with hepatic decompensation (OR = 2.068, P = .03). In patients with AUD, SUD, and particularly opioid use disorder, was independently associated with the diagnosis of ALD.