Future treatments of cirrhosis

Abstract

Cirrhosis can be sub-classified in clinical stages with distinct differences in prognosis and can even be reversed in some cases with successful etiological treatment. In this article, we review potential future therapies of cirrhosis, mainly focusing in the expansion of indications of currently licensed drugs. We strongly advocate that future therapies should focus on preventing the advent of complications and further progression of liver disease and should involve both primary and secondary care physicians. Such strategies could be based on the combination of currently licensed, relatively safe and inexpensive drugs and such randomized controlled trials should be prioritized in patients with advanced liver disease. The paradigm should be similar to that of prevention in cardiovascular diseases and long-term follow-up trials are needed.

Keywords::

• anticoagulation
• b-blockers
• cirrhosis
• hepatocellular carcinoma
• metformin
• mortality
• prevention
• statins
• warfarin

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Cirrhosis is responsible for 1 million deaths worldwide and affects people at working ages.

• Cirrhosis can be subclassified in clinical stages with distinct differences in prognosis.

• The dogma that prognosis is invariably dismal is not anymore valid.

• Early detection of patients with cirrhosis is key and population screening strategies need to be tested and implemented where applicable.

• Prevention of complications should be the focus of practicing physicians in primary and secondary care.

• This could be accomplished with a combination of lifestyle changes and currently available licensed drugs.

• Expansion of current indications of metformin, nonselective β-blockers, statins and anticoagulants would require randomized controlled trials.

• Better coordination of care is urgently warranted for patients with decompensated cirrhosis.