Medications for Alcohol Use Disorder Associated with Improved Mortality in Patients with Severe Alcohol-related Liver Disease

Alcohol-related liver disease (ALD) is now the most common reason for liver transplantation. Receipt of medications for alcohol use disorder (MAUD) is associated with reduced ALD progression, but they are seldom prescribed, especially for people with ALD. This study examined the association of MAUD receipt with mortality in 1309 patients referred for liver transplantation to a single tertiary care center with ALD as the primary cause of liver disease.

• At least one MAUD* was prescribed for 36 percent of the cohort. Those prescribed MAUD had higher Model of End-stage Liver Disease-Sodium scores, higher mean Charlson Comorbidity Index, and more hepatic decompensations.
• Receipt of a higher number of MAUDs and a longer duration of MAUD were both associated with reduced mortality, and these associations persisted after controlling for multiple potential confounders, with hazard ratios from 0.41 (unadjusted) to 0.59 (adjusted).
• More patients prescribed MAUD underwent liver transplantation than those with no MAUD prescriptions (39 percent versus 17 percent), but associations between MAUD receipt and survival were maintained in the cohort without liver transplantation.

* Defined as FDA-approved MAUD (naltrexone, acamprosate, and disulfiram), or medications commonly prescribed off-label for AUD (gabapentin, topiramate, and baclofen).

Comments: This study supports the administration of MAUD—even for patients with advanced ALD—with some dose-response effects, and after controlling for potential confounders. However, immortal time bias likely exaggerates the positive association of MAUD receipt and mortality, as patients starting MAUD after transplant referral would have life-years attributed to them prior to starting MAUD, when they could not have died. Extending the potential benefits of MAUD to those with severe ALD adds to the rationale for better access to MAUD for all levels of ALD.

Joseph Merrill, MD, MPH

Reference: Sundaresh R, Singh J, Meza J, et al. Medications for alcohol use disorder among patients with severe alcohol-related liver disease. JAMA Netw Open. 2026;9(2):e2559016.