Abstract
The current therapeutic strategies for the management of patients with cirrhosis rely on the prevention or treatment of specific complications. The removal of the causative agents (i.e., viruses or alcohol) prevents decompensation in the vast majority of patients with compensated cirrhosis. In contrast, even when etiological treatment has been effective, a significant proportion of patients with decompensated cirrhosis remains at risk of further disease progression. Therefore, therapies targeting specific key points in the complex pathophysiological cascade of decompensated cirrhosis could represent a new approach for the management of these severely ill patients. Some of the interventions currently employed for treating or preventing specific complications of cirrhosis or used in other diseases (i.e., poorly absorbable oral antibiotics, statins, albumin) have been proposed as potential disease-modifying agents in cirrhosis (DMAC) since clinical studies have shown their capacity of improving survival. Additional multicenter, large randomized clinical trials are awaited to confirm these promising results. Finally, new drugs able to antagonize key pathophysiological mechanisms are under pre-clinical development or at the initial stages of clinical assessment.
Highlights
In the natural history of liver cirrhosis, the onset of a major complication of the disease represents a crucial clinical event
The current therapeutic strategies aim to treat or control each complication individually [2]. Even though their efficacy has been proven in randomized clinical trials (RCTs), such approaches do not significantly affect the course of the disease, making it difficult to bring out a clear survival benefit for patients [3,4]
This review will critically analyze the available evidence supporting that interventions able to counteract key pathophysiological mechanisms can play a role as disease-modifying agents in cirrhosis (DMAC) in decompensated cirrhosis
Summary
In the natural history of liver cirrhosis, the onset of a major complication of the disease represents a crucial clinical event. About 5–7% of patients with compensated cirrhosis cross this border every year, entering a clinical history punctuated by further complications, frequent hospitalizations, worsening of quality of life and shortening of life expectancy [1] In this context, the current therapeutic strategies aim to treat or control each complication individually [2]. Novel therapeutic perspectives emerged relying on mechanistic approaches Their goal is to counteract key pathophysiological events: portal hypertension, bacterial translocation, circulatory dysfunction, systemic inflammation, oxidative stress, and immunological dysfunction. This kind of mechanism is exploited by disease-modifying agents (DMA) who have proven to exert beneficial effects on the course of a disease. This review will critically analyze the available evidence supporting that interventions able to counteract key pathophysiological mechanisms can play a role as DMAC in decompensated cirrhosis
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
