Open AccessPharmacotherapy of alcoholic liver disease in clinical practice
Author(s) -
Rosato V.,
Abenavoli L.,
Federico A.,
Masarone M.,
Persico M.
Publication year - 2016
Publication title -
international journal of clinical practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.756
H-Index - 98
eISSN - 1742-1241
pISSN - 1368-5031
DOI - 10.1111/ijcp.12764
Subject(s) - medicine , alcoholic liver disease , tolerability , acamprosate , abstinence , alcoholic hepatitis , intensive care medicine , disulfiram , pharmacotherapy , liver disease , wasting , naltrexone , cirrhosis , psychiatry , pharmacology , adverse effect , receptor , opioid
Summary Aims Alcohol is the most commonly used addictive substance and alcoholic liver disease (ALD) is a major cause of chronic liver disease worldwide, responsible for 47.9% of all liver chronic deaths. Despite ALD has a significant burden on the health, few therapeutic advances have been made in the last 40 years, particularly in the long‐term management of these patients. Methods we searched in PubMed, Scopus, Google Scholar, and MEDLINE databases to identify relevant English language publications focused on long‐term therapy of ALD. Results From the huge literature on this topic, including about 755 studies, 75 were selected as eligible including clinical trials and meta‐analysis. Conclusions Abstinence remains the cornerstone of ALD therapy but it is also the most difficult therapeutic target to achieve and the risk of recidivism is very high at any time. Several drugs (disulfiram, naltrexone, acamprosate, sodium oxybate) have proven to be effective to prevent alcohol relapse and increase the abstinence, although the psychotherapeutic support remains crucial. Baclofen seems to be effective to improve abstinence, showing an excellent safety and tolerability. ALD is often complicated by a state of malnutrition, which is related to a worst mortality. A nutritional therapy may improve survival in cirrhotic patients, reversing muscle wasting, weight loss and specific nutritional deficiencies. While in aggressive forms of alcoholic hepatitis are recommended specific drug treatments, including glucocorticoids or pentoxifylline, for the long‐term treatment of ALD, specific treatments aimed at stopping the progression of fibrosis are not yet approved, but there are some future perspective in this field, including probiotics and antibiotics, caspase inhibitors, osteopontin and endocannabinoids.