In 2023, there were significant advancements in trials of interventions to reduce mortality and morbidity from alcohol-related liver disease, spanning the entire spectrum of disease: primary prevention to reduce overall alcohol-related harm, secondary prevention to attenuate fibrosis progression and tertiary prevention using antibiotics for severe alcohol-associated hepatitis.
Key advances
-
Thirty-two months after implementation of a £0.50 minimum price for a unit of alcohol in Scotland, mortality wholly attributable to alcohol consumption decreased by 13%, in large part driven by a 12% reduction in deaths due to alcohol-related liver disease. The most socioeconomically deprived areas observed the largest improvements5.
-
The gut-selective antibiotic rifaximin-α did not reduce fibrosis stage compared with placebo after 18 months of treatment in a randomized controlled trial of patients with alcohol-related fibrosis, but it did prevent fibrosis worsening, possibly by attenuating hepatic inflammation6.
-
Prophylactic amoxicillin–clavulanate led to an absolute risk reduction of 4.7% for infections in patients with severe alcohol-associated hepatitis treated with glucocorticoids but did not improve 2-month survival. This finding does not support the use of prophylactic antibiotics in patients with severe alcohol-associated hepatitis10.
References
GBD 2017 Cirrhosis Collaborators. The global, regional, and national burden of cirrhosis by cause in 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet Gastroenterol. Hepatol. 5, 245–266 (2020).
Wester, A., Shang, Y., Stål, P. & Hagström, H. Time trends in mortality and life expectancy in 22,658 patients hospitalized with alcohol-associated cirrhosis: a nationwide cohort study. Hepatol. Commun. 7, e0279 (2023).
Singal, A. K. & Mathurin, P. Diagnosis and treatment of alcohol-associated liver disease: a review. JAMA 326, 165–176 (2021).
Karlsen, T. H. et al. The EASL Lancet Liver Commission: protecting the next generation of Europeans against liver disease complications and premature mortality. Lancet 399, 61–116 (2022).
Wyper, G. M. A. et al. Evaluating the impact of alcohol minimum unit pricing on deaths and hospitalisations in Scotland: a controlled interrupted time series study. Lancet 401, 1361–1370 (2023).
Israelsen, M. et al. Rifaximin-α for liver fibrosis in patients with alcohol-related liver disease (GALA-RIF): a randomised, double-blind, placebo-controlled, phase 2 trial. Lancet. Gastroenterol. Hepatol. 8, 523–532 (2023).
Hofer, B. S. et al. Alcohol abstinence improves prognosis across all stages of portal hypertension in alcohol-related cirrhosis. Clin. Gastroenterol. Hepatol. 21, 2308–2317 (2023).
Louvet, A. et al. Low alcohol consumption influences outcomes in individuals with alcohol-related compensated cirrhosis in a French multicenter cohort. J. Hepatol. 78, 501–512 (2023).
Otero Sanchez, L. et al. Clinical course and risk factors for infection in severe forms of alcohol-associated liver disease. Hepatology 74, 2714–2724 (2021).
Louvet, A. et al. Effect of prophylactic antibiotics on mortality in severe alcohol-related hepatitis: a randomized clinical trial. JAMA 329, 1558–1566 (2023).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
M.T. reports speaker fees from Echosens, Siemens, Norgine, Tillotts, Takeda and Madrigal; advisory fees from GE Healthcare, Boehringer Ingelheim and GSK; is a co-founder and board member of Evido.health; and is funded by grants from the Novo Nordisk Foundation (DECIDE, NNF 20OC0059393) and Horizon2020 (GALAXY, grant number 668031; LiverScreen, grant number 847989; MicrobPredict, grant number 825694). C.M. reports speaker fees from Echosens, Julius Clinical, Gilead Sciences and Surrozen.
Rights and permissions
About this article
Cite this article
Thiele, M., Moreno, C. Novel interventions against alcohol-related liver disease. Nat Rev Gastroenterol Hepatol 21, 78–79 (2024). https://doi.org/10.1038/s41575-023-00877-x
Published:
Issue Date:
DOI: https://doi.org/10.1038/s41575-023-00877-x
- Springer Nature Limited