P0989 - Naltrexone After Hospitalization for Patients With Alcohol Use Disorder and Alcohol-Associated Liver Disease Reduces Risks of Hepatic Decompensation and Mortality

Alexander K. Malik, MD¹, Bolin Niu, MD², Achintya D. Singh, MD, MBBS^3
1Summa Health System, Akron, OH; ²MetroHealth Medical Center, Cleveland, OH; ³MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH

Introduction: Naltrexone use in patients with alcohol use disorder (AUD) and alcohol-associated liver disease (ALD) has demonstrated improved clinical outcomes, including reduced risk of hepatic decompensation (HD) and improved mortality. However, physicians often under-prescribe naltrexone at the time of discharge. We aimed to explore demographic, racial trends of naltrexone prescription in the U.S. population.

Methods: A retrospective population-based cohort study was conducted using de-identified patient data from the TriNetX database. We identified patients admitted with a diagnosis of alcohol abuse and either ALD or unspecified cirrhosis of the liver. The primary aim was to identify proportion and characteristics of those who had naltrexone prescribed at discharge. The secondary aim was to compare outcomes between those who received naltrexone prescription at discharge to those who did not. Risks of HD, alcohol use remission, and mortality were compared using Kaplan-Meier methods. Patients actively using opioids or diagnosed with acute hepatitis, opioid dependence, or opioid abuse were excluded.

Results: We identified 10,231 patients eligible for naltrexone prescription, 5.56% of which were prescribed naltrexone (n=569) versus 94.43% were not prescribed naltrexone (n=9662). Patients prescribed naltrexone were younger and more likely to be White, not Hispanic or Latino, and affected by a concurrent mood or anxiety disorder (Table 1a). Among 558 propensity-matched patients, naltrexone was associated with a statistically significant lower risk of HD, greater likelihood of remission from alcohol abuse, and lower risk of mortality (Table 1b).

Discussion: Our results demonstrated that few eligible patients with AUD and ALD are prescribed naltrexone and that there are existing discrepancies regarding naltrexone prescription practices in terms of age, race, and ethnicity, with White race and non-Hispanic ethnicity associated with a higher likelihood of being prescribed naltrexone. Overlapping care from mental health and GI/hepatology specialists for patients with concurrent anxiety/mood disorders, AUD, and ALD may explain the observed association between concurrent mood/anxiety disorders and naltrexone prescription. Our analysis found that patients who were prescribed naltrexone had an associated lower risk of HD and mortality and higher likelihood of achieving sobriety, providing further evidence that naltrexone may be an important drug in managing the present pandemic of alcohol related liver diseases.



Disclosures:


Alexander K. Malik, MD¹, Bolin Niu, MD², Achintya D. Singh, MD, MBBS³. P0989 - Naltrexone After Hospitalization for Patients With Alcohol Use Disorder and Alcohol-Associated Liver Disease Reduces Risks of Hepatic Decompensation and Mortality, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.