The alcohol-associated hepatitis treatment landscape.

PURPOSE OF REVIEW: Alcohol-associated hepatitis is a severe form of alcohol-associated liver disease and is associated with a high mortality. Treatment of alcohol-associated hepatitis has historically been limited, with few therapies demonstrating survival benefit. However, multiple promising new therapies are on the horizon, with this review highlighting recent advances in alcohol-associated hepatitis treatment.

RECENT FINDINGS: Multiple new pharmacological agents targeting different mechanisms are under study for alcohol-associated hepatitis, including larsucosterol, F-652, and INT-787. Manipulation of the gut-brain axis has also been leveraged for alcohol-associated hepatitis, with use of fecal microbiota transplant and other modalities. Early liver transplantation, while not universally available, has offered improved survival with similar outcomes compared to other etiologies of liver disease. Living donor liver transplantation has also been investigated in alcohol-associated hepatitis, with promising results. While steroids still remain the mainstay of therapy, recent studies have offered nuances to their use, including use of a taper to reduce risk of infection without changing efficacy.

SUMMARY: Medical management of alcohol-associated hepatitis has remained largely unchanged since the 1970 s. However, promising therapies targeting multiple aspects of pathophysiology are on the horizon, including a planned phase 3 trial for larsucosterol, an active phase 2a study with INT-787 and a planned trial using F-652.