Pharmacotherapy for Alcohol Use Disorder Is Underutilized Among Commercially Insured Adults With Alcohol-Associated Liver Disease.
Alcohol use disorder (AUD) pharmacotherapy reduces hepatic decompensation and mortality in patients with alcohol-associated liver disease (ALD). We aimed to characterize the use of AUD pharmacotherapy in a large national cohort.Adults with AUD were identified in PharMetrics Plus for Academics-a nationally representative claims database of commercially insured Americans. We examined receipt of AUD therapy and associated treatment patterns.A total of 28,625 patients with AUD were identified: 1640 (5.7%) had ALD, among whom 439 (1.5%) had acute alcohol-associated hepatitis (AAH). Pharmacotherapy was prescribed in 14.5% of patients without ALD, 2.3% with ALD cirrhosis, and 9.8% with AAH. The most prescribed medication was gabapentin (9.4%). Among those receiving pharmacotherapy, one-time prescriptions were observed in 28.4% of patients without ALD, 10.7% with ALD cirrhosis, and 18.6% with AAH. The median time from diagnosis to receipt of pharmacotherapy was 10 months (interquartile range [IQR] 1.5-29.2). On regression analysis, nonsubstance use psychiatric diagnosis (adjusted odds ratio [aOR]: 2.71; 95% confidence interval [CI] [2.51, 2.93]) and female sex (aOR: 1.32; 95% CI [1.22, 1.42]) were associated with receipt of pharmacotherapy, while ALD cirrhosis (aOR: 0.22; 95% CI [0.14, 0.32]) and hepatic decompensation (aOR: 0.07; 95% CI [0.02, 0.16]) were associated with not receiving pharmacotherapy.AUD pharmacotherapy appeared underutilized in a large cohort of commercially insured U.S. adults, particularly among patients with ALD and hepatic decompensation. Providers caring for patients with AUD across the spectrum of liver disease should be aware of potential underutilization of these medications, especially among males and patients with cirrhosis.
