Utilizing Alcohol Use Disorder Pharmacotherapy in Hepatology, With Hersh Shroff, MD, MPA

New research is shedding light on low rates of prescriptions for alcohol use disorder (AUD) medications among liver transplant recipients with a history of alcohol-associated liver disease (ALD).1

The data were presented at the American Association for the Study of Liver Diseases (AASLD) The Liver Meeting 2025 by Hersh Shroff, MD, MPA, an assistant professor of medicine and director of the IHEAL Clinic at the University of North Carolina School of Medicine, and suggest gastroenterologists and hepatologists may be uncomfortable prescribing these medications in this patient population despite their proven safety and efficacy.1

“We know that those 2 conditions, the liver disease and the addiction, and sometimes a third condition of mental health, are all so intricately tied together that to me, you can't address one without addressing the others,” Shroff explained to HCPLive.

However, he notes many hepatologists are not trained to deal with addiction or mental health, creating a sense of discomfort among clinicians treating patients with ALD and AUD who may not fully understand how to approach the disease and may have misconceptions about utilizing AUD pharmacotherapy.

Previous research has shown alcohol use disorder pharmacotherapy is rarely utilized in patients with high-risk clinical history, including ALD. In one analysis of commercial insurance data from PharMetrics Plus for Academics, results showed only about 2% of eligible patients with ALD received a pharmacotherapy for AUD.2

To provide data contextualizing use of these medications in hepatology in the setting of transplantation, Shroff and colleagues conducted a retrospective study using deidentified patient data from Epic Cosmos for liver transplant recipients ≥ 18 years of age transplanted in the US between January 2015 and December 2023 with a diagnosis of ALD.1

Since the primary indication for transplantation is not available in Cosmos, investigators were unable to confirm that ALD was the primary indication for transplant. They included results of ethanol biomarkers any time after liver transplant and AUD medication prescriptions for baclofen, naltrexone, and acamprosate within 1 year after transplant.1

A total of 17,975 patients were included in the study cohort, representing 56% of all US liver transplants during the period. Among the cohort, the average age was 54 ±11 years at the time of transplant, 31% of patients were female, and 72% had a documented concomitant diagnosis of an alcohol-related disorder. Of 6168 (34%) patients with an available ethanol biomarker test, 913 (15%) were positive for an ethanol metabolite.1

During the study period, 3.4% of patients were prescribed a medication for alcohol use disorder within 1 year after liver transplant (1.9% baclofen, 0.84% naltrexone, 0.85% acamprosate). Investigators noted these prescriptions increased significantly during the study period, from 16 (2.0% of transplant recipients) in 2015 to 164 (6.2% of transplant recipients) in 2023 (P = .001). Specifically, baclofen prescriptions increased from 1.8% in 2015 to 2.0% in 2023 (P = .255), naltrexone increased from 0.8% in 2018 to 1.9% in 2023 (P = .093), and acamprosate increased from 1.0% in 2021 to 2.9% in 2023 (P = .324).1

“At meetings like this, all of us get together and share what we know and what our experience has been. I think sharing this more broadly with people, even outside of hepatology, [is important because] there's still a perception that a lot of these medications may be unsafe, and we're trying to dispel that notion,” Shroff said, additionally emphasizing the importance of patient involvement. “There's a perception and a stigma around using medications for various types of addiction, and I think it's important to break that. There's a big need for partnership and increased research, just like what we're doing.”

Editors’ Note: Shroff reports no relevant disclosures.

References

1. Shroff H, Fix O, Deutsch-Link S. Increasing Rates of Pharmacotherapy Prescriptions for Alcohol Use Disorder After Liver Transplantation: An Analysis of Epic Cosmos Data. Presented at the American Association for the Study of Liver Diseases (AASLD) The Liver Meeting 2025. Washington, DC. November 7-11, 2025.

2. Kunzmann K. Patients with Liver Disease Rarely Get Alcohol Use Disorder Pharmacotherapy. HCPLive. October 30, 2024. Accessed November 7, 2025. https://www.hcplive.com/view/patients-with-liver-disease-rarely-get-alcohol-use-disorder-pharmacotherapy