Association of Acamprosate Versus Gabapentinoids with Hospitalization and Total Mortality in Alcohol Use Disorder

Division

North Florida

Hospital

Osceola Regional Medical Center

Document Type

Manuscript

Publication Date

3-27-2025

Keywords

gabapentinoids, alcohol use disorder, cohort study, alcohol withdrawal, mortality

Disciplines

Internal Medicine | Medicine and Health Sciences

Abstract

IMPORTANCE: Alcohol use disorder (AUD) significantly increases hospitalizations and death. US Food and Drug Administration (FDA)-approved medications for AUD are underutilized. Gabapentinoids are not FDA-approved for AUD but are frequently prescribed by physicians.

OBJECTIVE: To examine the association of acamprosate and gabapentinoids on healthcare utilization and total mortality in patients with AUD.

METHODS: Two propensity score (PS)-matched retrospective cohort studies.

PARTICIPANTS: Veterans diagnosed with AUD (years 2003-2021) initiating acamprosate or gabapentinoids in an AUD-related encounter and not on chronic opioid therapy (AUD-cohort). Another PS-cohort of veterans who were hospitalized for AUD diagnoses (AUD-admission cohort). Subgroup analysis included people with chronic obstructive lung diseases, opioid use, and age categories.

MAIN OUTCOMES: Co-primary outcomes were admission for alcohol withdrawal (AW-admission) and annual rate of acute care events. Secondary outcome was total mortality.

RESULTS: We matched 16,072 pairs of acamprosate and gabapentinoid users in AUD-cohort. AW-admission occurred in 35.4% of the acamprosate users and 30.0% of the gabapentinoid users (odds ratio [OR]: 1.28, 95% confidence interval [95% CI]: 1.22-1.34). Annual rate of acute care events in acamprosate and gabapentinoid users were 1.84 and 1.64, respectively (coefficient of regression [β]: 0.20, 95% CI: 0.12-0.28). There was no difference in total mortality (hazard ratio: 0.96, 95% CI: 0.91-1.005). In subgroup analysis, acamprosate use was associated with less total mortality in subgroups of people using opioids and older than 60 years.

CONCLUSION: Gabapentinoids are associated with reduced AW-admission and lower annual rates of acute care events compared to acamprosate. Gabapentinoids may offer a viable alternative for AUD in carefully selected populations.

Publisher or Conference

Journal of Hospital Medicine

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