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

Background: Alcohol use is the most important factor in determining the prognosis of patients with alcohol-related cirrhosis and alcohol-associated hepatitis. Aims: Conduct a systematic review of interventions for alcohol use disorder specific to patients with cirrhosis or alcohol-associated hepatitis. Method: Five databases were searched 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 a meta-analysis was performed. Results: 23 studies met the inclusion criteria including 6 randomised trials and 17 nonrandomised 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 which were significant in multivariate models. This was in response to psychological therapy, use of any pharmacotherapy, and use of any treatment. Meta-analysis of non-randomised studies which examined the impact of psychological therapies revealed 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) which were not statistically significant. Conclusion: Baclofen is the only intervention with randomised trial evidence for significant benefit in patients with cirrhosis. Non-randomised studies also point to nonpharmaceutical interventions improving clinical outcomes