Can Medications for Excessive Alcohol Use Help Prevent and Treat Alcohol-Related Liver Disease?

BOSTON – Excessive alcohol consumption can harm the liver, causing a range of conditions from relatively minor liver damage to serious problems such as cirrhosis and liver cancer—all of which fall under the umbrella of alcohol-associated liver disease (ALD). Though medications that help patients reduce their alcohol intake exist, they are widely under-prescribed.

New research led by investigators at Massachusetts General Hospital (MGH) and published in JAMA Network Open suggests that receiving medications that reduce alcohol consumption may lower the risk of ALD among individuals with alcohol use disorder, and also slow disease progression in patients already diagnosed with ALD.

The retrospective study analyzed information from the Mass General Brigham Biobank, an ongoing research initiative that has been recruiting patients since 2010. Among 9,635 patients with alcohol use disorder who were included in this study, 1,135 (11.8%) had ALD and 3,906 (40.5%) were treated with medications for alcohol use disorder, including disulfiram, acamprosate, naltrexone, gabapentin, topiramate, and baclofen.

Among participants without ALD, those who received medications for alcohol use disorder had a 63% lower odds of later developing ALD than untreated patients (over an average follow-up of 8.8 and 9.2 years after diagnosis of alcohol use disorder in untreated and treated patients, respectively). Such treatment was also linked with a 59% lower risk of disease progression in patients who had already been diagnosed with cirrhosis. Associations between different drugs and such outcomes varied, however.

"Our findings indicate that medical treatment for excessive alcohol use may have a meaningful role to play in preventing liver disease," says lead author Augustin Vannier, BA, research fellow at the MGH Alcohol Liver Center.

"While prospective randomized clinical trials are warranted to determine the true benefits of addiction medications for alcohol abuse disorder for the prevention and treatment of ALD, we are hopeful that these results will provide further support for the use of medical therapy for alcohol, which tends to be underutilized," adds Jay Luther MD, Director of the MGH Alcohol Liver Center and an assistant professor of Medicine at Harvard Medical School.

Other study authors include Augustin G.L. Vannier, BA, Jessica E.S. Shay, MD, PhD, Valdislav Fomin, MD, Suraj J. Patel, MD, PhD, Esperance Schaefer, MD, MPH, and Russell P. Goodman, MD, PhD.

This work was supported by the National Institutes of Health.

About the Massachusetts General Hospital Alcohol Liver Center

The Mass General Alcohol Liver Center strives to advance the care of patients with alcohol-related liver disease, a leading cause of liver disease, through clinical and research innovation. The center takes a comprehensive, multidisciplinary approach to the clinical care of patients with alcohol-related liver disease. The team consists of liver specialists (hepatologists), addiction medicine physicians, specialized nurses, transplant liver physicians and social workers, all of whom work together to provide the best possible to care our patients. Additionally, the center is also dedicated to research advancing the understanding of the causes of alcohol-related liver disease and improving therapies to prevent and treat alcohol-related liver disease. The research program spans the spectrum of clinical, translational and basic science work and includes prominent investigators committed to defeating this disease.

About the Massachusetts General Hospital

Massachusetts General Hospital, founded in 1811, is the original and largest teaching hospital of Harvard Medical School. The Mass General Research Institute conducts the largest hospital-based research program in the nation, with annual research operations of more than $1 billion and comprises more than 9,500 researchers working across more than 30 institutes, centers and departments. In August 2021, Mass General was named #5 in the U.S. News & World Report list of "America’s Best Hospitals." MGH is a founding member of the Mass General Brigham health care system.