Individuals with severe alcohol-related liver disease (ALD) who take alcohol use disorder (AUD) medications have higher survival rates over three years, according to a study in JAMA Network Open.Why It’s Relevant
A mainstay of treatment for ALD is to avoid alcohol, as sobriety can stabilize or even reverse liver injury. For individuals with comorbid ALD and AUD, behavioral or peer support may not be enough to achieve sobriety—yet data suggest that fewer than 1% of people with ALD nationwide receive AUD medications such as acamprosate or naltrexone.
By the Numbers
- Researchers assessed the survival rates of 1,309 patients (76% male) with severe ALD who were referred to a tertiary medical center for a liver transplant evaluation.
- At evaluation, 467 patients (35.7%) were taking an AUD pharmacotherapy—which included FDA-approved medications (acamprosate, disulfiram, and naltrexone) or common off-label prescriptions (baclofen, gabapentin, and topiramate).
- Individuals who used AUD medications for at least three months had a 6.6% higher one-year survival rate and an 18.5% higher three-year survival rate compared with those who used AUD medications for three months or less.
- As medication duration increased, mortality decreased: Just 12.6% of patients with more than six months of AUD medication use died during follow-up, compared with 34.7% of those with no medication use.
What’s More
One possible explanation for the survival difference is that patients taking AUD medications were healthier—but the data showed those taking medications were in slightly worse shape at baseline, with more severe liver disease and more medical comorbidities.
The Other Side
The data come from a single tertiary referral center, so the findings may have limited generalizability. Also, the researchers were unable to factor in non-pharmacological support the patients may have been receiving for their AUD.
Takeaway Message
Clinician hesitancy—often due to a lack of knowledge about AUD management—has been cited as a factor in the low prescribing of AUD medications for patients with liver disease. The present findings offer evidence for long-term mortality benefits with AUD medication use, “even among patients with multiple decompensations who are referred for liver transplant.”
Related Information
Source
Ram Sundaresh, et al. Medications for alcohol use disorder among patients with severe alcohol-related liver disease. JAMA Network Open. Published February 11, 2026. doi:10.1001/jamanetworkopen.2025.59016
(Image: Getty Images/iStock/PonyWang)
