Review Article

Current and Emerging Therapies for the Management of Cirrhosis and its Complications

Elliot B. Tapper; Nneka N. Ufere; Daniel Q. Huang; Rohit Loomba

Disclosures

Aliment Pharmacol Ther. 2022;55(9):1099-1115. 

In This Article

Abstract and Introduction

Abstract

Background: Cirrhosis is increasingly common and morbid. Optimal utilisation of therapeutic strategies to prevent and control the complications of cirrhosis are central to improving clinical and patient-reported outcomes.

Methods: We conducted a narrative review of the literature focusing on the most recent advances.

Results: We review the aetiology-focused therapies that can prevent cirrhosis and its complications. These include anti-viral therapies, psychopharmacological therapy for alcohol-use disorder, and the current landscape of clinical trials for non-alcoholic steatohepatitis. We review the current standard of care and latest developments in the management of hepatic encephalopathy (HE), ascites and hepatorenal syndrome. We evaluate the promise and drawbacks of chemopreventative therapies that have been examined in trials and observational studies which may reduce the risk of hepatocellular carcinoma and cirrhosis complications. Finally, we examine the therapies which address the non-pain symptoms of cirrhosis including pruritis, muscle cramps, sexual dysfunction and fatigue.

Conclusion: The improvement of clinical and patient-reported outcomes for patients with cirrhosis is possible by applying evidence-based pharmacotherapeutic approaches to the prevention and treatment of cirrhosis complications.

Introduction

Cirrhosis is common and morbid. Its prevalence exceeds >1 million persons in the United States (US) alone,[1] rising by 50% in the past 20 years.[2] Hospitalisations for cirrhosis have increased by 90% and their rate now exceeds that for heart failure.[3] Cirrhosis mortality has risen by 65% since 2008.[4] Despite these poor indicators, there has been substantial progress in supportive care for cirrhosis with interventions that enrich quality of life and prevent the development of cirrhosis complications. Effort to optimise therapy for cirrhosis care and prevention will improve public health. Herein, we provide a narrative review of the state-of-the art for the pharmacotherapeutic management and prevention of cirrhosis complications.

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