E0514 - Patients With Alcoholic Cirrhosis Are Less Likely to Receive Treatment for Alcohol Use Disorder Compared to Their Non-Cirrhotic Counterparts

Tuesday, October 25, 2022

3:00 PM – 5:00 PM ET

Location: Crown Ballroom

Has Audio

Presenting Author(s)

Syed Ahmad Adil, MD

University Hospitals/CMC
Cleveland, OH

Syed Ahmad Adil, MD¹, Akash Khurana, MD², Adrian Lindsey, MD³, Perica Davitkov, MD⁴
¹University Hospitals/CMC, Cleveland, OH; ²University Hospitals of Cleveland, Cleveland, OH; ³University Hospitals, Cleveland, OH; ⁴Case Western Reserve University, Cleveland, OH

Introduction: Effective treatment for alcoholism involves pharmacotherapy and psychosocial support. Naltrexone, Acamprosate, and Disulfiram are FDA-approved for moderate-severe alcoholism. Although abstinence remains the cornerstone in management of alcoholic cirrhosis (AC), these patients often have less access to treatment modalities, including pharmacotherapy. In this study, we sought to investigate the discrepancies in pharmacologic treatment of alcohol use disorder in patients with AC compared to non-cirrhotics.

Methods: We queried a commercial database (Explorys Inc, Cleveland, OH), an aggregate of EHR data from 27 integrated healthcare systems in the United States between 5/2017-5/2022. We identified all patients in the database with AC and alcoholism based on Systematized Nomenclature of Medicine-Clinical Terms (SNOMED-CT). We compared the prevalence of pharmacologic treatment for alcoholism with Naltrexone, Acamprosate, or Disulfiram at least 30 days following diagnosis of AC to a control cohort of patients with alcoholism without AC.

Results: Of the 31,306,880 patients in the database, 310,470 patients had a diagnosis of alcoholism, excluding AC, and 62,670 patients had AC. Overall prevalence of Acamprosate use was 1.47% in the group with AC and 2.32% in the group with alcoholism with odds ratio (OR) for AC 0.63 [95% CI, 0.59-0.67, p< 0.001]. Odds of treatment with Acamprosate tended to be lower in patients with AC who were Hispanic/Latino (OR 0.38) or had a major mood disorder such as depression (OR 0.27) or bipolar disorder (OR 0.39). Overall prevalence of Naltrexone use was 1.79% in AC and 4.95% in alcoholism with odds ratio (OR) for AC 0.35 [95% CI, 0.33-0.37, p< 0.001]. As with Acamprosate, odds of treatment with Naltrexone tended to be lower in patients with AC who identified as Hispanic/Latino or had a co-existing mood disorder. Though not as commonly prescribed, overall prevalence of Disulfiram use was 0.45% in AC and 1.21% in alcoholism with odds ratio (OR) for AC 0.37 [95% CI, 0.32-0.41, p< 0.001].

Discussion: In this population-based study, patients with AC were less likely to be treated for their alcohol use disorder with FDA-approved drugs compared to non-cirrhotics. Though incompletely understood, this may be related to the highly stigmatized nature of the disease, provider bias, and patient-related factors such as socioeconomic status and adherence. One possible explanation for naltrexone specifically, is that it is contraindicated in acute hepatitis and advanced cirrhosis.

X	Alcoholic Cirrhosis (AC)	Prevalence per 100,000	Alcoholism without Cirrhosis	Prevalence per 100,000	Odds Ratio	95% CI	P-value
Total	920	1468	7200	2319	0.63	0.59- 0.67	< 0.001
Adults (age 18-65)	740	1870	5930	2598	0.71	0.66- 0.77	< 0.001
Seniors (age >65)	190	815	1320	1592	0.51	0.44- 0.59	< 0.001
Female	360	1827	3000	3062	0.59	0.53- 0.66	< 0.001
Male	570	1388	4210	2069	0.67	0.61-0.73	< 0.001
Caucasian	780	1819	6120	3033	0.6	0.55- 0.64	< 0.001
African American	80	1099	640	1352	0.81	0.64- 1.02	0.078
Hispanic/Latino	40	897	280	2310	0.38	0.27-0.53	< 0.001
Anxiety Disorder	670	3018	5710	3803	0.79	0.73- 0.85	< 0.001
Major Depressive Disorder	660	3088	5480	10528	0.27	0.25- 0.29	< 0.001
Bipolar Disorder	230	4675	2220	11028	0.4	0.34- 0.46	< 0.001
x	x	x	x	x	x	x	x
x	Alcoholic Cirrhosis (AC)	Prevalence per 100,000	Alcoholism without Cirrhosis	Prevalence per 100,000	Odds Ratio	95% CI	P-value
Total	1120	1787	15360	4947	0.35	0.33-0.37	< 0.001
Adults (age 18-65)	900	2274	13430	5885	0.37	0.35-0.4	< 0.001
Seniors (age >65)	230	987	1970	2375	0.41	0.36-0.47	< 0.001
Female	440	2234	6210	6339	0.34	0.31-0.37	< 0.001
Male	660	1607	9010	4427	0.35	0.33-0.38	< 0.001
Caucasian	900	2099	12210	6051	0.33	0.31-0.36	< 0.001
African American	140	1923	1870	3952	0.48	0.41-0.57	< 0.001
Hispanic/Latino	50	1121	510	4208	0.26	0.19-0.35	< 0.001
Anxiety Disorder	820	3964	11860	7898	0.45	0.42-0.48	< 0.001
Major Depressive Disorder	800	3744	11490	22075	0.14	0.13-0.15	< 0.001
Bipolar Disorder	280	5691	4330	21510	0.22	0.19-0.25	< 0.001
x	x	x	x	x	x	x	x
x	Alcoholic Cirrhosis (AC)	Prevalence per 100,000	Alcoholism without Cirrhosis	Prevalence per 100,000	Odds Ratio	95% CI	P-value
Total	280	447	3770	1214	0.37	0.32-0.41	< 0.001
Adults (age 18-65)	220	556	3110	1363	0.41	0.35-0.46	< 0.001
Seniors (age >65)	60	257	670	808	0.32	0.24-0.41	< 0.001
Female	90	457	1530	1562	0.29	0.23-0.36	< 0.001
Male	190	463	2240	1101	0.42	0.36-0.48	< 0.001
Caucasian	230	537	3210	1591	0.33	0.29-0.38	< 0.001
African American	30	412	220	465	0.89	0.6-1.3	0.535
Hispanic/Latino	20	448	160	1320	0.34	0.21-0.54	< 0.001
Anxiety Disorder	190	856	2740	1825	0.46	0.4-0.54	< 0.001
Major Depressive Disorder	190	889	2680	5149	0.17	0.14-0.19	< 0.001
Bipolar Disorder	80	1626	990	4918	0.32	0.25-0.4	< 0.001

Table: Top: Prevalence of Acamprosate use after at least 30-days post-Alcoholic Cirrhosis (AC) or Alcoholism diagnosis
Middle: Prevalence of Naltrexone use after at least 30-days post-Alcoholic Cirrhosis (AC) or Alcoholism diagnosis
Bottom: Prevalence of Disulfiram use after at least 30-days post-Alcoholic Cirrhosis (AC) or Alcoholism diagnosis

Disclosures:

Syed Ahmad Adil indicated no relevant financial relationships.

Akash Khurana indicated no relevant financial relationships.

Adrian Lindsey indicated no relevant financial relationships.

Syed Ahmad Adil, MD¹, Akash Khurana, MD², Adrian Lindsey, MD³, Perica Davitkov, MD⁴. E0514 - Patients With Alcoholic Cirrhosis Are Less Likely to Receive Treatment for Alcohol Use Disorder Compared to Their Non-Cirrhotic Counterparts, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.