TY  - JOUR
N1  - Copyright © 2024 The Authors. Published by Elsevier B.V. on behalf of European Association for the Study of the Liver (EASL). This is an
open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
IS  - 4
TI  - AlcoChange: A digital therapeutic for patients with alcohol-related liver disease
AV  - public
VL  - 6
Y1  - 2024/04//
JF  - JHEP Reports
KW  - Alcohol-related liver disease; alcohol; digital health; digital therapeutic;
smartphone
A1  - Mehta, Gautam
A1  - Lin, Su
A1  - Nadar, Aida
A1  - PV, Bharadwaj
A1  - Kumar, Ravi
A1  - Balaji, Anu
A1  - Macdonald, Stewart
A1  - Sheikh, Mohammed F
A1  - Saeidinejad, MohammadMahdi
A1  - Sharma, Shiv-Raj
A1  - King, Ji J
A1  - Mookerjee, Rajeshwar P
A1  - McDonagh, Lorraine
A1  - Afuwape, Sarah A
A1  - Moore, Kevin
A1  - Jalan, Rajiv
ID  - discovery10188683
N2  - Background & Aims:
Maintenance of abstinence in alcohol-related liver disease (ARLD) is a major unmet therapeutic need. Digital therapeutics can deliver ongoing behavioural therapy, in real-time, for chronic conditions. The aim of this project was to develop and clinically test AlcoChange, a novel digital therapeutic for ARLD.
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Methods:
AlcoChange was developed using validated behaviour change techniques and a digital alcohol breathalyser. This was an open-label, single-centre study. Patients with ARLD, ongoing alcohol use (within 1 month) and possession of a suitable smartphone were eligible. Patients were recruited from inpatient and outpatient settings, and received AlcoChange therapy for 3 months. The primary outcome was reduction in alcohol use from baseline to 3 months, measured by timeline follow-back. Secondary outcomes included: (i) compliance with the AlcoChange app, (ii) alcohol-related and all-cause hospital re-admissions up to 1 year, (iii) qualitative analysis to determine factors associated with compliance.
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Results:
Sixty-five patients were recruited, of whom 41 completed the study per protocol. Patients compliant with the intervention (>60 logins over 3 months) had a significant reduction in alcohol use from baseline compared to non-compliant patients (median [IQR]: -100% [100% to -55.1%] vs. -57.1% [-95.3% to +32.13%], p = 0.029). The proportion attaining abstinence at 3 months was higher in the compliant group (57.1% vs. 22.2%, p = 0.025). The compliant group had a significantly decreased risk of subsequent alcohol-related re-admission up to 12 months (p = 0.008). Qualitative analysis demonstrated that receiving in-app feedback and the presence of a health-related ?sentinel event? were predictors of compliance with the intervention.
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Conclusions:
Use of the novel digital therapeutic, AlcoChange, was associated with a significant reduction in alcohol use and an increase in the proportion of patients with ARLD attaining abstinence. Definitive randomised trials are warranted for this intervention.
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Impact and implications:
Alcohol-related liver disease (ARLD) is an increasing health problem worldwide. The main cause of death and disability in ARLD is ongoing alcohol consumption, but few patients receive medications or talking therapy to maintain abstinence. This study demonstrated that a digital therapeutic, linked to a smartphone, may help reduce alcohol consumption and alcohol-related hospital admissions in these patients. If validated in larger, randomised, trials, digital therapeutics may have a role in the primary and secondary prevention of complicatons from ARLD.
SN  - 2589-5559
PB  - Elsevier BV
UR  - http://dx.doi.org/10.1016/j.jhepr.2023.100993
ER  -