S161 Trends and Outcomes of Alcoholic Acute Pancreatitis in Patients With Alcohol Use Disorder Treated With Naltrexone in the United States: Before and After the COVID-19 Pandemic

Introduction: Alcohol use disorder (AUD) is a well-established risk factor for alcoholic acute pancreatitis (AAP). While medication for AUD (MAUD) use has been used for alcohol-associated liver disease, its application in AAP remains unclear. We aimed to assess the temporal trends in AAP incidence and the impact of naltrexone use on clinical outcomes in AUD patients. Methods: We conducted a retrospective cohort study using de-identified patient data from the TriNetX database, including all adults (≥18 years) diagnosed with AUD. AAP patients were then identified and stratified by naltrexone exposure. The incidence and prevalence of AAP in AUD patients were assessed pre- (March 2015 to 2019) and post-COVID-19 (March 2020 to 2025). Baseline characteristics were compared between patients treated and those not treated with naltrexone. Propensity score matching was performed to adjust for confounders. The primary outcomes included mortality, chronic pancreatitis, alcoholic hepatitis, cirrhosis, hospital readmission, and emergency department visits at 1, 6, and 12 months. Results: Among 1,331,338 adults with AUD, 33,561 (2.52%) developed AAP. The incidence of AAPs increased significantly following the COVID-19 pandemic (1.42% pre-pandemic vs 1.98% post-pandemic), with the largest relative rise among younger adults (18–34 years), women, and racial minorities. Of those with AAP, 1,871 (5.6%) received naltrexone. Compared with patients with AAP not treated with naltrexone, those receiving naltrexone were younger (46.1 vs 50.8 years, P < 0.0001), more likely to be Hispanic (14% vs 9%, P < 0.0001), and had higher rates of coexisting anxiety (66% vs 44%) and mood disorders (63% vs 43%, both P < 0.0001). Following propensity score matching, naltrexone use was associated with significantly lower odds of mortality at 1 (odds ratio [OR] 0.274, 95% CI, 0.136–0.554; P < 0.0001) and 6 months (OR 0.571, P = 0.005), with a non-significant trend at 12 months (OR 0.785, P = 0.141). Reduced odds were also observed for alcoholic hepatitis at 1 month (OR 0.561, P < 0.0001) and hospital readmissions across all time points (ORs 0.304–0.488, all P < 0.0001). Surprisingly, naltrexone use was associated with an increased risk of emergency department visits after matching. Conclusion: Naltrexone use has been associated with improved short-term mortality and lower risk of hospital readmission. These findings support expanding MAUD use in AAP population, a group that may benefit from the therapeutic and harm reduction benefits of MAUD treatment.