Alcohol Dependence and Alcoholic Liver Disease

Summary of Presentations from the H. Lundbeck A/S-Supported Symposium, held at the 49th Annual International Liver Congress, London, United Kingdom, on 10th April 2014

*Karl Mann,1 Sebastian Mueller2

1. Department of Addictive Behaviour and Addiction Medicine, Central Institute of Mental Health,  Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany
2. Department of Internal Medicine, Salem Medical Center and Center for Alcohol Research,  University of Heidelberg, Heidelberg, Germany
*Correspondence to Karl.Mann@zi-mannheim.de

Disclosure: Prof Mann has received speaker fees and research grants for Lundbeck, Pfizer paid for participation on the advisory board. Dr Mueller has received speaker fees for Lundbeck and Echosens.
Acknowledgements: Medical writing assistance was provided by Dr Caroline Charles (Scilink Medical Writing, Biarritz, France).
Citation: EMJ Hepatol. 2015;3[1]:20–26.

Meeting Summary

Alcohol dependence is a disabling condition that has a high prevalence, but in Europe only a small fraction of the people diagnosed with alcohol abuse and dependence are treated, representing the widest treatment gap, as compared with other mental disorders. Early diagnosis and monitoring of alcoholic liver disease (ALD) is still insufficiently solved. Although ALD is the most common cause for liver disease in the Western world, it largely remains underestimated and underdiagnosed for many reasons. The recent introduction of non-invasive elastographic techniques such as transient elastography (TE) has significantly improved the early diagnosis of alcoholic liver cirrhosis (ALC). As demonstrated in the literature, inflammation-associated liver stiffness (LS) rapidly decreases during alcohol detoxification, and is also directly correlated to change in LS in both abstinent and relapsing patients. Newly published data show that LS could be used to monitor and validate hepatoprotective effects during nalmefene usage.

Nalmefene is an opioid system modulator that diminishes the reinforcing effects of alcohol, helping the patient to reduce drinking. Three randomised, multicentre, double-blind, placebo-controlled, parallelgroup Phase III studies were designed to assess the efficacy and safety of nalmefene in reducing alcohol consumption. Patients with a high or very high drinking risk level (DRL) at baseline and randomisation show a clinically significant effect from nalmefene treatment, which is generally well tolerated. Moreover, reduced alcohol consumption supported by nalmefene in combination with psychosocial support may indeed help to reduce the alcohol-related burden and the large treatment gap.

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