Ayyala 2022: naltrexone in people with liver disease and cirrhosis

What they tested

Researchers looked back at the records of adults with and without liver disease who were prescribed naltrexone for alcohol use disorder between 2015 and 2019 in a safety-net health system, one that cares for many patients regardless of ability to pay.

They compared liver enzyme levels before, during and after the prescription, and tracked hospital stays and deaths over 2 years. Of the 160 patients, 100 (63%) had liver disease, and 47 of those (47%) had cirrhosis. 47% of the cirrhosis cases were decompensated, meaning the scarred liver had started to cause serious complications.

What they found

In the whole group, in people with liver disease and in people with cirrhosis, average AST and ALT were lower after the naltrexone prescription than before (p < 0.001).

Two-year survival was 97.7% without liver disease, 95.4% with liver disease but no cirrhosis, 90.8% with cirrhosis and 81.3% with decompensated cirrhosis. These differences were not statistically significant (p = 0.46).

Alcohol-related hospital stays over 2 years rose with the severity of liver disease: 8.2%, 27.7%, 40.5% and 41.7% across the same four groups (p = 0.007).

Liver disease (HR 3.70) and cirrhosis (HR 5.16) predicted later hospital stays, and so did a short naltrexone prescription of 30 days or less (HR 2.50). A hazard ratio above 1 means a higher risk.

Limits

• It was a look back at records, and the abstract describes no comparison group that didn't get naltrexone. It shows what happened on naltrexone, not what naltrexone caused.
• It came from one safety-net health system and included 160 patients.
• Few people had decompensated cirrhosis, the survival estimates for that group were wide, and the authors say more safety data are needed for them.
• A shorter prescription was linked to more hospital stays, but the study can't say whether that reflects the medicine or the kind of people who stopped early.

What it means if you're considering naltrexone

Naltrexone's labels carry a liver warning, and the authors note that data in people with liver disease are limited. In this study, liver enzymes went down rather than up after people started naltrexone, including people with cirrhosis.

It is a records study from one health system, so it is reassuring rather than final, especially for people whose cirrhosis is decompensated.