23 - Pharmacologic Therapy for Alcohol Use Disorder Is Under-Utilized in Alcohol-Associated Liver Disease Among Commercially Insured U.S. Adults

Alex R. Jones, MD¹, Yue Jiang, PhD², Meena M. Tadros, BS¹, Olgert Bardhi, MD¹, Prajwal Gowda, BS¹, Madhukar Patel, MD, MBA¹, Ben Lippe, PhD¹, Van Ngo, PharmD³, Mary Olumesi, PharmD¹, Raelene Trudeau, PharmD¹, Jessica Whitt, PharmD¹, Layne Jordan, MD¹, Alvaro Noriega Ramirez, BS¹, Akhil Shenoy, MD⁴, Arjmand Mufti, MD¹, Thomas Cotter, MD¹, Mack Mitchell, MD¹, Lisa B. VanWagner, MD, MSc¹, Amit G. Singal, MD, MS⁵, Sarah R. Lieber, MD, MSCR^1
1University of Texas Southwestern Medical Center, Dallas, TX; ²Duke University, Chapel Hill, NC; ³University of Texas Southwestern Medical Center, Dallas, UT; ⁴Columbia University Irving Medical Center, New York, NY; ⁵University of Texas Southwestern, Dallas, TX

Introduction: Alcohol use disorder (AUD) is present in over half of patients with alcohol-associated liver disease (ALD). Treatment of AUD in ALD reduces morbidity and mortality—pharmacotherapy is an important modality for treating addiction and preventing progression of liver disease. We aimed to characterize pharmacologic treatment patterns and factors associated with pharmacologic therapy among AUD patients with and without liver disease including acute alcoholic hepatitis (AAH).

Methods: Adult patients with AUD were identified from 2006-2021 using IQVIA PharMetrics^® Plus for Academics, a nationally representative database of commercially insured Americans. The primary outcome was receipt of AUD pharmacologic therapy any time after index AUD diagnosis. We used multivariable logistic regression to identify factors associated with receipt of AUD pharmacotherapy.

Results: We identified a total of 28,625 patients with AUD: 26,985 without ALD, 1,201 with ALD, and 439 with AAH (Table 1); pharmacologic therapy was prescribed in 3,924 (14.5%) of patients without ALD, 28 (2.3%) with ALD, and 43 (9.8%) with AAH. One-time prescriptions were seen in 1,113 (28.4%) of the non-ALD, 3 (10.7%) of the ALD, and 8 (18.6%) of the AAH patients. The median time to prescription was 302 (IQR 45-876) days with no significant difference based on presence of liver disease (Table 1, p=0.51). Gabapentin was the most commonly prescribed medication (9.4%) followed by oral naltrexone (2.6%) and topiramate (2.1%). In a multivariable logistic regression model, age ≥50 years (aOR 1.33, 95% CI [1.23, 1.43]), female sex (aOR 1.31, 95% CI [1.22, 1.41]), non-liver Charlson Comorbdity Index ≥3 (aOR 2.21, 95% CI [1.80, 2.71]), and psychiatric comorbidity (aOR 2.76, 95% CI [2.56, 2.98]) were associated with receipt of pharmacotherapy. Presence of hepatic decompensation (ascites, hepatic encephalopathy, or bleeding varices) (aOR 0.08 95% CI [0.03, 0.17]) and non-AAH ALD (aOR 0.24, 95% CI [0.16, 0.35]) were associated with lower odds of receiving pharmacotherapy.

Discussion: In a large nationally representative cohort of commercially insured patients, AUD pharmacotherapy was underutilized in at risk populations, especially patients with ALD, among whom just 1 in 50 received AUD therapy. Providers caring for patients with ALD should consider this underutilized therapy, or refer for psychiatric consultation when appropriate.



Disclosures:


Alex R. Jones, MD¹, Yue Jiang, PhD², Meena M. Tadros, BS¹, Olgert Bardhi, MD¹, Prajwal Gowda, BS¹, Madhukar Patel, MD, MBA¹, Ben Lippe, PhD¹, Van Ngo, PharmD³, Mary Olumesi, PharmD¹, Raelene Trudeau, PharmD¹, Jessica Whitt, PharmD¹, Layne Jordan, MD¹, Alvaro Noriega Ramirez, BS¹, Akhil Shenoy, MD⁴, Arjmand Mufti, MD¹, Thomas Cotter, MD¹, Mack Mitchell, MD¹, Lisa B. VanWagner, MD, MSc¹, Amit G. Singal, MD, MS⁵, Sarah R. Lieber, MD, MSCR¹, 23, Pharmacologic Therapy for Alcohol Use Disorder Is Under-Utilized in Alcohol-Associated Liver Disease Among Commercially Insured U.S. Adults, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.