Systematic review: Interventions for alcohol use disorder in patients with cirrhosis or alcohol associated hepatitis

Oldroyd, Christopher, Greenham, Olivia, Allison, Michael, Martin, Graham and Notley, Caitlin ORCID: (2023) Systematic review: Interventions for alcohol use disorder in patients with cirrhosis or alcohol associated hepatitis. Alimentary Pharmacology and Therapeutics. ISSN 0269-2813

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Background: Alcohol use is the most important factor in determining the prognosis of patients with alcohol-related cirrhosis and alcohol-associated hepatitis. Aim: To conduct a systematic review of interventions for alcohol use disorder specific to patients with cirrhosis or alcohol-associated hepatitis. Methods: We searched five databases between inception and November 2022. The primary outcomes were abstinence, hepatic decompensation and mortality. We included randomised and non-randomised studies. Risk of bias was assessed using validated tools. Where possible, meta-analysis was performed. Results: Twenty-three studies met the inclusion criteria including six randomised trials and 17 non-randomised studies of interventions. These included 104,298 patients with a mean/median age range from 44 to 65, of whom 75% were male. Interventions included psychological therapy, pharmacological therapies, specialist clinics, patient education and low alcohol drinks. Baclofen was the only intervention to demonstrate a statistically significant impact on the primary outcomes in a randomised trial (abstinence OR: 6.3, 95% CI: 2.4–16.1). Three non-randomised studies reported reductions in episodes of hepatic decompensation that were significant in multivariate models. This was in response to psychological therapy, use of any pharmacotherapy, and use of any treatment. A meta-analysis of non-randomised studies that examined the impact of psychological therapies revealed statistically non-significant improvements in abstinence (4 studies, OR: 1.87, 95% CI: 0.38–9.23) and mortality (4 studies, OR: 0.47, 95% CI: 0.12–1.77). Conclusions: Baclofen is the only intervention with randomised trial evidence for significant benefit in patients with cirrhosis. Non-randomised studies also point to non-pharmaceutical interventions possibly improving clinical outcomes.

Item Type: Article
Additional Information: Funding Information: This study was funded in full by a National Institute for Health and Care Research doctoral fellowship awarded to Dr Christopher Oldroyd (NIHR 302571).
Uncontrolled Keywords: alcohol use disorder,alcohol-associated hepatitis,alcohol-related cirrhosis,baclofen,meta-analysis,pharmacotherapy,psychological therapy,systematic review,gastroenterology,pharmacology (medical),hepatology,sdg 3 - good health and well-being ,/dk/atira/pure/subjectarea/asjc/2700/2715
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
UEA Research Groups: Faculty of Medicine and Health Sciences > Research Centres > Norwich Institute for Healthy Aging
Faculty of Medicine and Health Sciences > Research Groups > Epidemiology and Public Health
Faculty of Medicine and Health Sciences > Research Groups > Public Health and Health Services Research
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Depositing User: LivePure Connector
Date Deposited: 07 Aug 2023 09:31
Last Modified: 08 Sep 2023 08:30
DOI: 10.1111/apt.17665

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