Return to drinking occurs in 22% of alcohol-associated hepatitis patients within 90 days of recovery

This analysis combined data from a Phase 2b RCT and a prospective observational study within the AlcHepNet multicenter consortium. It followed 518 patients with alcohol-associated hepatitis who were alive at Day 28, tracking return to drinking (RTD) at 30, 90, and 180 days. The study did not report on specific interventions or comparators, focusing instead on the natural history of alcohol use post-diagnosis.

The cumulative incidence of RTD was 7.7% at 30 days, 21.7% at 90 days, and 30.8% at 180 days. At 180 days, patients with moderate AH (MELD 11-19, n=103) had a significantly higher RTD rate than those with severe AH (MELD ≥20, n=415): 44.3% versus 27.5% (p=0.01). Multivariable analysis identified key predictors: a history of >20 drinking days in the month prior to AH diagnosis was associated with a substantially increased risk of RTD (HR 3.46, 95% CI: 2.21-5.39), while having a college education or higher was protective (HR 0.53, 95% CI: 0.32-0.88).

Safety and tolerability data were not reported. The study's key limitations include its observational design for the predictive analyses, which can only show associations, not causation. The population was drawn from specific multicenter studies, and generalizability to all AH patients is uncertain. Funding sources and conflicts of interest were not disclosed.

For practice, this analysis quantifies the high and early risk of alcohol relapse in AH survivors, underscoring the critical window for addiction treatment. The identified risk factors (heavy pre-diagnosis drinking) and protective factors (higher education) can help clinicians stratify follow-up intensity. However, management decisions should be based on established AUD therapies, as this study did not test specific interventions.