Alcohol-associated liver disease: emerging therapeutic strategies
File(s)HEP-24-0582.R1_Proof_hi.pdf (1.04 MB)
Accepted version
Author(s)
Mullish, Benjamin H
Thursz, Mark R
Type
Journal Article
Abstract
The large and growing burden of alcohol-associated liver disease—and the considerable burden of morbidity and mortality associated with it—has been a drive toward ongoing research into novel strategies for its treatment, with a particular focus upon alcohol-associated hepatitis (AH). Management of alcohol-use disorder forms the central pillar of alcohol-associated liver disease care, with evidence-based psychological and pharmacological approaches being well established, and certain models demonstrating improved clinical outcomes when hepatology and addiction services are co-located. Corticosteroids have previously been used somewhat indiscriminately in patients with severe AH, but effective tools now exist to assess early response (and limit futile ongoing exposure). Techniques to predict risk of corticosteroid-related infection are also available, although current clinical strategies to mitigate this risk are limited. A variety of novel therapeutic approaches to AH are at different phases of trials and evidence gathering, with some of the most promising signals related to cytokine manipulation, epigenetic modulation, and targeting of the gut microbiota (ie, by means of fecal microbiota transplant). While remaining an ongoing source of debate, early liver transplant in severe AH has grown in interest and acceptability over the past decade as evidence supporting its efficacy builds, in the process challenging paradigms about mandatory pretransplant sobriety periods. However, uncertainty remains regarding the optimal selection criteria, and whether liver transplant has a role for only a highly limited proportion of patients with AH or more widespread application. This review aims to provide an overview of this fast-moving field.
Date Issued
2024-12-01
Date Acceptance
2024-06-08
Citation
Hepatology, 2024, 80 (6), pp.1372-1389
ISSN
0270-9139
Publisher
Lippincott, Williams & Wilkins
Start Page
1372
End Page
1389
Journal / Book Title
Hepatology
Volume
80
Issue
6
Copyright Statement
Copyright © 2024 American Association for the Study of Liver Diseases. This is the author’s accepted manuscript made available under a CC-BY licence in accordance with Imperial’s Research Publications Open Access policy (www.imperial.ac.uk/oa-policy)
License URL
Identifier
https://journals.lww.com/hep/fulltext/9900/alcohol_associated_liver_disease__emerging.933.aspx
Publication Status
Published
Date Publish Online
2024-06-26