Current and future treatment for alcoholic-related liver diseases

The socioeconomic burden of alcohol-related liver disease has been increasing worldwide. Its prevalence is underestimated, and patients with alcohol-related liver disease are rarely diagnosed in the earlier phase of the disease spectrum. Alcoholic hepatitis is a distinct syndrome with life-threatening signs of systemic inflammation. In severe alcoholic hepatitis, prednisolone is indicated as the first-line treatment even with the possibility of various complications. Early liver transplantation can be another option for highly selected patients with a null response to prednisolone. Most importantly, abstinence is the mainstay of long-term care, but relapse is frequent among patients. Recent findings on the pathogenesis of alcoholic hepatitis have enabled us to discover new therapeutic targets. Preventing hepatic inflammation, reducing oxidative stress, improving gut dysbiosis, and enhancing liver regeneration are the main targets of emerging therapies. Herein, we review the pathogenesis, current treatment, and barriers to successful clinical trials of alcoholic hepatitis. Additionally, clinical trials for alcoholic hepatitis, either ongoing or recently completed, will be briefly introduced.

Automated summary

The socioeconomic burden of alcohol-related liver disease is increasing globally. Its prevalence is underestimated and early diagnosis is rare. Alcoholic hepatitis, a life-threatening syndrome, is characterized by systemic inflammation. Prednisolone is the first-line treatment for severe alcoholic hepatitis, with liver transplantation as an option for non-responders. Abstinence is crucial for long-term care, and new therapeutic targets aim to prevent hepatic inflammation, reduce oxidative stress, improve gut dysbiosis, and enhance liver regeneration. This review covers the pathogenesis, current treatment, and barriers to clinical trials of alcoholic hepatitis, as well as ongoing or recently completed trials.