S2342 Medications for Alcohol Use Disorder Improve Survival in Patients With Alcohol-Associated Hepatitis

Introduction: Addressing alcohol use disorder (AUD) is a paramount step in the management of alcohol-associated liver diseases. Emerging data are suggestive of improved outcomes in patients with alcohol-associated cirrhosis when prescribed medications for alcohol use disorder (MAUD), such as naltrexone or acamprosate. However, data on the use of MAUD in alcohol-associated hepatitis (AH) are lacking. In this study, we aim to assess outcomes of AH in patients who are receiving MAUD. Methods: We conducted a retrospective cohort study using TriNetX, a global multi-institutional federated research database, on adults (≥18 years) diagnosed with AH over a 20-year period from May 2004 to April 2024. Patients were divided into 2 groups: those who were prescribed naltrexone or acamprosate within 1 month of AH diagnosis and those who were not. To control for confounders, 1:1 propensity score matching was performed based on age, sex, and medical comorbidities. We excluded patients with viral hepatitis, Wilson’s disease, autoimmune hepatitis, or obstructive jaundice. Matched cohorts were analyzed for 6-month outcomes. Our primary outcome was all-cause mortality. Secondary outcome assessed liver transplantation at 6 months. Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were calculated. Results: We identified 44,694 patients with AH, of whom 2,468 (5.51%) were exposed to MAUD within the first month of AH diagnosis. Patients with MAUD were younger (mean age 43.1 vs 47.6 years; P < 0.001). Propensity score matching resulted in 2,464 patients in each group. Those who were exposed to MAUD had 50% lower rates of mortality when compared to those who were not (aOR 0.503, 95% CI 0.42-0.59). Rates of liver transplantation were low and similar in both groups (aOR 0.635, 95% CI 0.38-1.05). Conclusion: Our study highlights an alarmingly low utilization of MAUD in AH patients, yet we found significantly better survival in those who were exposed to MAUD within 1 month of AH diagnosis. This is a reflection of the importance of early interventions to address underlying AUD in this patient population. Efforts should be directed to improve access and raise awareness about the safety and efficacy of MAUD in treating AUD in patients with AH.