Novel Treatments for Alcoholic Hepatitis

Margarita N. German; Jessica Musto; Michael R. Lucey

Disclosures

Curr Opin Gastroenterol. 2021;37(3):179-186. 

In This Article

Abstract and Introduction

Abstract

Purpose of Review: The current article aims to review the latest literature on updates in therapeutics for alcohol-associated liver disease (ALD), integration of treatment of alcohol use disorder (AUD) into the management of ALD, and the role of liver transplantation for alcoholic hepatitis.

Recent Findings: ALD has recently become the most common indication for liver transplantation due to the increasing prevalence of AUD and the paucity of therapeutic options. There is broad consensus on the importance of early identification of AUD and the incorporation of its treatment in the management of ALD. New targets for treatment of alcoholic hepatitis include the gut–liver axis, anti-inflammatory drugs, antioxidants, and drugs with hepatic regenerative potential. Fecal transplantation in particular has had favorable outcomes at 1 year. n-Acetylcysteine in addition to corticosteroids, granulocyte colony stimulating factor, and IL-22 have also shown improved short-term outcomes. A number of other therapies are being studied in clinical trials and their results are anxiously awaited.

Summary: In summary, there are several promising therapeutic options under clinical investigation for the treatment of alcoholic hepatitis and ALD; however, alcohol abstinence is key. In the absence of other effective therapies, liver transplantation for ALD remains a life-saving treatment with excellent patient and graft survival.

Introduction

Alcohol-associated liver disease (ALD) comprises a substantial proportion of the overall cirrhosis burden in the United States and worldwide and has emerged as the most common indication for liver transplantation in the United States.[1,2] Rising rates of alcohol use disorder (AUD) and high-risk drinking over the past 2 decades have further contributed to the rising prevalence of ALD.[2] The coronavirus disease 2019 (COVID-19) pandemic, which began in November 2019, has further exacerbated this growing disease with emerging data showing changes in global alcohol use patterns, namely an increase in alcohol consumption, especially among those with preexisting AUD.[3,4] Patients with AUD and ALD may be among those populations severely impacted by this pandemic, related to delays in seeking medical care, increased risk of severe COVID-19 infection, and social isolation.[5] On the contrary, only a minority of patients with newly diagnosed ALD receive specific therapy for AUD, which almost never includes pharmacotherapy to control drinking.[6] Furthermore, there is a paucity of effective therapies for ALD, including alcoholic hepatitis, an advanced form of ALD characterized by acute inflammation related to prolonged heavy alcohol use.[2]

The current review will discuss the current understanding of alcoholic hepatitis, provide an update on advances in therapies for ALD, discuss the need to incorporate the treatment of AUD into therapeutic plans for alcoholic hepatitis and ALD, and finally, review liver transplantation in patients with ALD.

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