Review article: current and emerging therapies for the management of cirrhosis and its complications

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.

FIGURE 1

Aetiology directed therapies to prevent decompensations of cirrhosis. Patients with cirrhosis may have multiple disease aetiologies. Efforts to address alcohol use, lifestyle change and elimination or control of viral hepatitis are essential

FIGURE 2

The physiological basis of therapies to prevent and manage cirrhosis complications. AKI, acute kidney injury; BCAA, branch‐chain amino acids; HRS, hepatorenal syndrome; US, United States