Medications for alcohol use disorder in alcohol-related cirrhosis

Background
Alcohol Use Disorder (AUD) and Alcohol Lives Disease (ALD) are prevalent health conditions with a significant burden of disease, and they affect millions of people worldwide. AUD affects 237 million men and 46 million women worldwide being more prevalent in high-income countries. The prevalence of this disorder has increased in many countries and its prevalence in the general population is estimated at 8.8%.  Alcohol consumption is the main factor for AUD and ALD, estimating that 48% of liver disease is alcohol attributable. Heavy drinking (more than 4 standard drinks unit per day) and prolonged consumption are associated with increased risk of both AUD and ALD. About 90% of patients with heavy drinking had steatosis, 40% fibrosis and between 8 and 20% cirrhosis. Despite the high comorbidity of ALD in AUD, the role of medications for alcohol use disorder (MAUD) in patients with ALD is not well established due to a scarcity of efficacy and safety evidence. 
Methods
We conducted a systematic review in PubMed, Embase, and Scopus, including all studies until May 2022, and and meta-analysis (PRISMA guidelines). The population was defined as patients with both conditions (AUD and cirrhosis). The primary outcome was alcohol abstinence being safety  a secondary outcome. A random-effect analysis (RR of alcohol use) was performed only for RCTs. Heterogeneity was assessed by I2 .
Results
4095  reference were screened and 8 studies were selected meaning 4 different drugs (six studies for baclofen, one study for metadoxine, one study for acamporsate and one study for microbiota transplant) for 794 patients. Four out of eight were RCTs that were included in the meta-analysis. Relative risk was 0.68 (CI: 0.48-0.97), P = 0.03] in favour of treatment arm ( I2 = 67%). One-hundred sixty-five serious events were identified (only 3% possible/probable related to treatment, n=5).
Conclusions
MAUD increasing alcohol abstinence by 32% compared to placebo or standard treatment, and have a good safety profile. However, we found a high heterogeneity and few studies, especially RCTs for drugs approved by FDA or EMA (acamprosate, naltrexone) or recommended by guidelines (gabapentine, topiramate).  Further RCTs for AUD in ALD, especially in advanced liver disease are needed. 
NOTE: This study is already published (https://pubmed.ncbi.nlm.nih.gov/37625154/). However, authors considered to submit this short-communication because 1) submission guidelens doesn't advice against published studies; 2) dissemination of results is highly likely of interest to audience of the Conference. 
Gratacós-Ginès J, Bruguera P, Pérez-Guasch M, López-Lazcano A, Borràs R, Hernández-Évole H, Pons-Cabrera MT, Lligoña A, Bataller R, Ginès P, López-Pelayo H, Pose E. Medications for alcohol use disorder promote abstinence in alcohol-associated cirrhosis: Results from a systematic review and meta-analysis. Hepatology. 2023 Aug 25. doi: 10.1097/HEP.0000000000000570.