The pharmacological management of alcohol-related cirrhosis: what's new?
| Autor: | Verma N; Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India., Vinod AP; Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India., Singal AK; Department of Medicine, Division of Gastroenterology and Hepatology, University of Louisville School of Medicine, Louisville, KY, USA.; Department of Transplant Hepatology, Jewish Hospital and Trager Transplant Center, Louisville, Kentucky, USA.; Department of Research, Veteran Affairs Medical Center, Sioux Falls, SD, USA. |
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| Jazyk: | angličtina |
| Zdroj: | Expert opinion on pharmacotherapy [Expert Opin Pharmacother] 2024 Oct; Vol. 25 (14), pp. 1923-1941. Date of Electronic Publication: 2024 Oct 03. |
| DOI: | 10.1080/14656566.2024.2409941 |
| Abstrakt: | Introduction: Alcohol use disorder (AUD) is present in the majority of patients with alcohol-associated liver disease (ALD), which leads to about 50% of cirrhosis-related hospitalizations and over 25% of deaths worldwide. Patients with ALD often present at an advanced stage, like cirrhosis with its complications and alcohol-associated hepatitis (AH), which has high short-term mortality. Current treatments are limited, with the limited benefit of glucocorticoids only in the short-term among patients with AH, highlighting an urgent need for novel therapies. Areas Covered: This review applies the PIRO (Predisposition, Injury, Response, Organ dysfunction) concept to ALD, understanding an ongoing process of liver damage, and opportunities to address and halt the progression. We also highlight the significance of treating AUD to improve long-term outcomes in ALD. Expert Opinion: Personalized therapies targeting specific genetic profiles and multiple pathogenic pathways are crucial in managing ALD. Emerging therapies like gut-liver-brain axis modulators like fecal microbiota transplant and probiotics, interleukin-22, granulocyte-colony stimulating factor (G-CSF) and stem cells, epigenetic regulators of inflammation and regeneration are encouraging with the potential of efficacy in patients with ALD. Liver transplantation (LT) is a definitive therapy for advanced cirrhosis with increasing impetus on early LT select patients with active alcohol use. |
| Databáze: | MEDLINE |
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