Medication trajectories during the year following the initiation of medication indicated for alcohol use disorder

Five medications for alcohol use disorder (MAUD) are indicated in France: acamprosate, disulfiram, naltrexone, and, since 2014, baclofen and nalmefene. Few studies have focused on the initiation of MAUD, and none have described their use during the first year. The objective of this study was to characterize MAUD trajectories during the year following initiation and to identify factors associated with non-persistence. A population-based cohort study was conducted among patients who initiated MAUD between 2014 and 2020 using the French National Health Data System. Individual MAUD trajectories during the year following initiation were described, and logistic regression was performed to investigate factors associated with non-persistence at 28 days. A total of 817,297 patients initiated a MAUD. The annual number of initiations decreased from 150,049 in 2014 to 85,884 in 2020. After 28 days, 60.1% of initiators discontinued their medication. Non-persistence was more common among patients who initiated baclofen, were female, lived in more deprived areas, received their initial prescription from a general practitioner, or had no comorbidities. Over the study period, MAUD use decreased in France, with frequent early discontinuation. Further investigations are needed to identify barriers to persistence and develop strategies for improving adherence and effectiveness.