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Chapter 6.14: Alcohol Use Disorders: Alcoholic Liver Diseases and Alcohol Dependency

Priority Medicines for Europe and the World


"A Public Health Approach to Innovation"

Background Paper



Alcohol Use Disorders: Alcoholic Liver Diseases and Alcohol Dependency

Opportunities to Address Pharmaceutical Gaps

By Warren Kaplan, Ph.D, JD, MPH
7 October 2004


Table of Contents




Executive Summary 4

Burden of Disease 4

Treatment Options 4

1. Introduction 5

1.1 Alcohol Addiction 5

1.2 Alcoholic Liver Diseases 6

1.2.1 Alcoholic Fatty Liver 6

1.2.2 Alcoholic Hepatitis 6

1.2.3 Alcoholic Cirrhosis 6

1.3 Diagnosis of Alcohol Abuse or Dependence 6

1.3.1 The DSM Criteria 7

1.3.2 ICD Criteria 7

2. What Are the Epidemiological Trends for Europe and the World 7

2.1 General 7

2.1.1 Prevalence of Alcohol Abuse 7

2.1.2 Prevalence of ALD 10

2.2 The European Burden of ALD 10

2.3 Several Specific Epidemiologic Issues Exist with the Main Types of Alcoholic Liver Disease 13

2.3.1 Immunomodulatory Effects of Alcohol 13

2.3.2 ALD and the Elderly 14

2.3.3 ALD and Women 14

2.3.4 ALD and Genetics 15

2.3.5 Diagnosis and Biochemical Markers 16

2.3.6 Comorbidities Associated with Alcohol Abuse and Dependence 17

3. What is the Control Strategy? 17

3.1 Remediation of Alcohol Dependence 17

3.2 Alcoholic Liver Disease (ALD) 18

3.2.1 Alcoholic Hepatitis (AH) 18

3.2.2 Alcoholic Cirrhosis 19

3.3 Transplantation 20

4. What is Known of the Affordability, Feasibility, and Sustainability of the Control Strategy? 21

4.1 Economic Burden 21

4.2 Feasibility of Control Strategy 22

5. Why Does the Disease Burden Persist? 22

6. What Can Be Learnt from Past/Current Research into Pharmaceutical Interventions for this Condition? 23

6.1 Dependence 23

6.2 Liver Regeneration 23

7. What is the Current “Pipeline” of Products that Are to Be Used for this Particular Condition? 24

7.1 Alcohol Dependence 24

7.1.1 Opioid Antagonists 24

7.1.2 Serotonergics 24

7.1.3 Dopaminergics 24

7.1.4 Other Interventions 24

7.2 Alcoholic Liver Disease 25

7.3 “Spillovers” from the Hepatitis C pipeline and Other Fibrotic Conditions 28

8. What is the Current Status of Institutions and Human Resources Available to Address the Disease? 30

8.1 Public Funding 30

8.1.1 European Sources of Funding for Alcoholic Liver Diseases: Selected Countries 30

8.1.2 United States Sources of Funding 31

8.2 Private Sector Funding 31

9. Ways Forward from a Public Health Viewpoint with Regard to Public Funding 32

9.1 Gaps between current research and potential research issues which could make a difference. 32

9.1.1 Basic Research 32

9.1.2 Applied Research 33



10. Conclusion 33

Annex
Appendix



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