Alcohol use disorder in community management of chronic liver diseases

Hepatology, Год журнала: 2022, Номер 77(3), С. 1006 - 1021

Опубликована: Апрель 18, 2022

Rising rates of alcohol use disorder (AUD) combined with increases in alcohol‐related liver disease (ALD) and other have resulted the need to develop management strategies at all levels patient care. For those pre‐existing disease, whether ALD or others, attention treatment abstinence becomes critical avoiding worsening liver‐related consequences. Modalities help patients reduce stop include screening/brief intervention/referral treatment, various therapeutic modalities including cognitive behavioral therapy, motivational enhancement therapy 12‐step facilitation, relapse prevention medications. Harm reduction approaches versus total may be considered, but for existing ALD, particularly advanced (cirrhosis acute alcoholic hepatitis), from is recommendation, given clear data that ongoing worsens mortality morbidity. certain populations, cessation even more critically important. hepatitis C NAFLD, accelerates negative outcomes. In women, damage results worsened mortality. Efforts integrate AUD care are urgently needed can occur several levels, establishment multidisciplinary clinics fully integrated co‐management as an important goal.

Язык: Английский

---

New insights into the molecular basis of alcohol abstinence and relapse in alcohol-associated liver disease

Hepatology, Год журнала: 2023, Номер unknown

Опубликована: Окт. 20, 2023

Alcohol use disorder remains a significant public health concern, affecting around 5% of adults worldwide. Novel pathways damage have been described during the last years, providing insight into mechanism injury due to alcohol misuse beyond direct effect ethanol byproducts on liver parenchyma and neurobehavioral mechanisms. Thus, gut-liver-brain axis immune system involvement could be therapeutic targets for disorder. In particular, changes in gut microbiota composition function, bile acid homeostasis, shown with consumption cessation. can also directly disrupt intestinal blood-brain barriers. Activation triggered by barrier dysfunction translocation bacteria, pathogen-associated molecular patterns (such as lipopolysaccharide), cytokines, damage-associated patterns. These factors, turn, promote brain inflammation progression fibrosis. Other involved mechanisms include oxidative stress, apoptosis, autophagy, release extracellular vesicles miRNA from hepatocytes. Potential (probiotics fecal transplantation), neuroinflammatory pathways, well neuroendocrine example, ghrelin (ghrelin receptor blockade), incretin mimetics (glucagon-like peptide-1 analogs), mineralocorticoid (spironolactone). addition, support psychological behavioral treatments is essential address multiple dimensions future, personalized approach considering these novel contribute significantly decreasing alcohol-associated burden disease.

Язык: Английский

---

Medications for treating alcohol use disorder: A narrative review

Alcohol Clinical and Experimental Research, Год журнала: 2023, Номер 47(7), С. 1224 - 1237

Опубликована: Май 25, 2023

Chronic heavy alcohol use impacts all major neurotransmitter systems and is associated with multiple medical, psychiatric, social problems. Available evidence-based medications to treat disorder (AUD) are underutilized in clinical practice. These promote abstinence or reduce consumption, though there questions regarding their optimal dosage, length of treatment, utility combination one another. Pharmacogenetic approaches, which a patient's genetic make-up inform medication selection, have garnered great interest but yet yield results robust enough incorporate them routine care. This narrative review summarizes the evidence both for approved by Food Drug Administration (disulfiram, oral naltrexone, acamprosate, extended-release naltrexone) those commonly used off-label (e.g., gabapentin, baclofen, topiramate) AUD treatment. We discuss these drugs' mechanisms action, use, pharmacogenetic findings, treatment recommendations. conclude that most consistent supporting pharmacotherapy opioid antagonists, naltrexone nalmefene (which not United States), topiramate. demonstrate small moderate effects reducing frequency drinking and/or drinking. Lastly, we make suggestions research needed refine expand current literature on effective AUD.

Язык: Английский

---

Mapping Dialectical Behavior Therapy Skills to Clinical Domains Implicated in Contemporary Addiction Research: A Conceptual Synthesis and Promise for Precision Medicine

Cognitive and Behavioral Practice, Год журнала: 2024, Номер unknown

Опубликована: Сен. 1, 2024

Язык: Английский

---

Emerging drugs in phase II and III clinical development for the treatment of alcohol use disorder

Expert Opinion on Emerging Drugs, Год журнала: 2024, Номер 29(3), С. 219 - 232

Опубликована: Апрель 12, 2024

Alcohol Use Disorder (AUD) poses an ongoing significant global health burden. AUD is highly prevalent and affects not only the individuals with AUD, but also their communities society at large. Even though pharmacotherapy integral part of treatment, few available substances show limited efficacy clinical impact. Thus, there a need for new innovative pharmacotherapeutic approaches. This paper provides comprehensive review drugs approved treatment as well those currently in phase II III development. Data from recent trials has been reviewed supplemented by additional literature based on systematic search PubMed database registries. Compounds discussed include disulfiram, naltrexone, nalmefene, acamprosat, baclofen, sodium oxybate, doxazosin, varenicline, zonisamide, gabapentin, apremilast, ibudilast, ivermectin, tolcapone, mifepristone, suvorexant, ketamine, psilocybin, semaglutide, oxytocin cannabidiol. majority compounds lack sufficient evidence to support efficacy, multiple promising options are under investigation. Future research consider specific phenotypes subgroups possible enhancement effects psychotherapy through combination pharmacotherapy. Practitioners should be encouraged use existing therapeutic regimens.

Язык: Английский

---

Psychosocial and medication interventions to stop or reduce alcohol consumption during pregnancy

Cochrane library, Год журнала: 2024, Номер 2024(4)

Опубликована: Апрель 29, 2024

Язык: Английский

---

Pharmacological Treatments for Alcohol Use Disorder: Considering the Role of Sex and Gender

Current Addiction Reports, Год журнала: 2024, Номер 11(1), С. 81 - 93

Опубликована: Янв. 3, 2024

Язык: Английский

---

Treatment of alcohol use disorder in patients with alcohol-associated liver disease: Innovative approaches and a call to action

Addiction Science & Clinical Practice, Год журнала: 2024, Номер 19(1)

Опубликована: Март 19, 2024

Abstract Alcohol-associated liver disease is currently the leading cause of transplantation and deaths both in Europe United States. Efficacious treatments exist for alcohol use disorder, but they are seldomly prescribed patients who need them. Besides, presence cirrhosis can complicate pharmacological treatment choices. In this review, we discuss established innovative strategies to treat unhealthy with alcohol-associated disease. We also describe experience our own institutions, Hospital Universitari Germans Trias i Pujol Badalona (Spain) Yale-New Haven Health Yale Medicine (Connecticut. States America).

Язык: Английский

---

Endpoints for Pharmacotherapy Trials for Alcohol Use Disorder

Pharmaceutical Medicine, Год журнала: 2024, Номер 38(4), С. 291 - 302

Опубликована: Июль 1, 2024

Alcohol use disorder (AUD) is a debilitating disorder, yet currently approved pharmacotherapies to treat AUD are under-utilized. The three medications by the US Food and Drug Administration (FDA) for indication of disulfiram, acamprosate, naltrexone. current landscape suggests opportunities improvement. Clinical trials investigating novel traditionally abstinence-based drinking outcomes or no heavy days as trial endpoints determine efficacy pharmacotherapies. These typically measured through patient self-report endorsements their drinking. Apart from these traditional outcomes, there have been recent developments in include utilizing World Health Organization (WHO) risk level reductions promote harm-reduction endpoint rather than an endpoint. Additionally, contrast measurements, biological markers alcohol may serve objective pharmacotherapy trials. Lastly, National Institute on Abuse Alcoholism (NIAAA) definition recovery patient-oriented offer new frameworks consider associated with more consumption itself, such provider-patient experiences promising future development, so long validity reliability measures demonstrated endpoints. A greater breadth utilization better capture complexity symptomatology.

Язык: Английский

---

Medications for Alcohol Use Disorder Are Increasingly Being Prescribed in American Patients With Advanced Liver Disease

The American Journal of Gastroenterology, Год журнала: 2025, Номер unknown

Опубликована: Янв. 21, 2025

The number of alcohol use disorder patients with mild (n=101) and severe alcoholic liver disease (n=112) increased between 2013 2023 (p=0.06). Naltrexone was prescribed in 65%, acamprosate 26% disulfiram 9%. Internal medicine providers were the most frequent prescribers (51%) followed by Psychiatry (30%), GI/Hepatology (9%) (p=0.001). Duration longest naltrexone compared to (360 vs 251 190 days, p=0.032). rate AUD medication discontinuation for adverse events similar both groups (14% 12%). Naltrexone, acamprosate, are increasingly being American ALD tolerability efficacy.

Язык: Английский

---