Promising medications, biologics, and interventions that address the pathophysiology of alcohol-associated hepatitis are in clinical trials, according to the authors of a review article. Liver regeneration, blocking inflammatory pathways, restoring a normal microbiome, or a combination of these are the most common treatments under testing.
Among the approaches are a recombinant fusion protein of human interleukin-22 (an anti-inflammatory and pro-regenerative cytokine) and granulocyte colony-stimulating factor (G-CSF) plus standard medical therapy. “The role of gut microbiota in the pathogenesis of alcohol-associated hepatitis is another area of development,” the authors write. “A promising pilot study showed that fecal microbiome transplantation from healthy donors was associated with lower mortality than in a historical cohort. A study of interleukin-1 inhibition by anakinra, pentoxifylline, and zinc showed an acceptable side-effect profile, but 180-day survival did not differ significantly between the combination therapy and glucocorticoid therapy. Several clinical trials are now examining the role of probiotics, rifaximin, and fecal microbiome transplantation in patients with alcohol-associated hepatitis. Other targeted trials under way involve the use of antiinflammatory drugs (interleukin-1β inhibition by canakinumab), drugs targeting gut–liver axis dysfunction and dysbiosis (broad-spectrum antibiotics and bovine colostrum), antioxidants (N-acetylcysteine, metadoxine, and n–5 fatty acids), drugs targeting apoptosis (selonsertib and emricasan), phage therapy, and supplemental nutrition strategies.”