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. 2024 Nov 5;12:goae097. doi: 10.1093/gastro/goae097

Table 3.

Potential medical therapies for AH

Treatment Mechanism of action Clinical trial outcomes Side effects Additional considerations
Corticosteroids (prednisolone, prednisone, methyl-prednisolone) Anti-inflammatory Reduction in short- to medium-term mortality, but increased risk of infections and no long-term mortality benefit Weight gain, indigestion, sepsis, gastro-intestinal hemorrhage, restlessness Controversial due to risks of sepsis and hemorrhage; effectiveness limited to short-term
Pentoxifylline Hemorrhagic agent Initially showed short-term benefits; recent studies show no benefit Gastro-intestinal complaints, dizziness, headaches, flushing Controversial due to initial positive results; however, recent results showed no benefit
Bovine colostrum (IMM-124E) IgG to LPS, reduces bacterial translocation Decrease in serum endotoxin levels at 7 months Gastro-intestinal complaints, rash, unpleasant taste Phase II, not recruiting
Lactobacillus rhamnosus GG Changes in gut microbiome Decreased liver injury 1 month post-LGG therapy Rash, pruritis, swelling, dizziness, throat swelling RCT
Amoxicillin-clavulanate Interference with bacterial cell wall synthesis No difference to prednisolone alone Gastro-intestinal complaints, rash RCT
Anakinra (+ zinc) IL-1 receptor antagonist; anti-inflammatory; immunomodulation Survival at 6 months; improved outcomes in combination but not statistically significant mortality benefit Infection risks given immunomodulatory effect Combined with zinc and pentoxifylline in trials; requires further investigation
Selonsertib (GS-4997) ASK-1 antagonist, inhibits MAPK, JNK, p38 Safety and serious adverse events at 28 days plus 30 days Headache, nausea Phase II, completed
Emricasan (IDN-6556) Pan-caspase inhibitor Survival at 28 days High-blood-level concerns, headache, nausea, fatigue Study terminated after five patients
Larsucosterol Epigenetic modulator inhibiting DNA methylation Reduces risk of mortality (41% reduction, P =0.07) among AH patients No unexpected serious adverse events May now enter a Phase 3 trial with the goal of Food Drug Administration (FDA) approval in the near future
Obeticholic acid (INT-747) FXR activation, bile acid agonist, anti-inflammatory Change in MELD score at 6 weeks Pruritus, fatigue, gastro-intestinal disorders Phase II, completed
Metadoxine Antioxidant; promotes abstinence; increases hepatic glutathione concentrations Survival at 30 days; improved survival and sobriety rates in small trials Nausea, upset stomach, diarrhea Phase IV, recruiting; dual effects on liver health and sobriety maintenance promising but require larger studies
IL-22 (F-652) Anti-inflammatory and hepatic regeneration Safety and serious adverse events at 42 days; preliminary data showed efficacy signals in a small cohort study Dermal inflammation, ancanthosis Phase I completed; Phase IIb RCT underway
G-CSF (filgrastim) Increases neutrophils, hepatic regeneration Survival at 2 and 6 months depending on CS response; mortality benefit in small clinical studies Bone pain, injection-site reactions Phase IV, active and recruiting; results from larger trials are eagerly awaited
Infliximab TNF-α inhibitor Improvement in Maddrey's score; increased infection risk Increased risk of infections Not recommended due to serious infection risk
Etanercept TNF-α inhibitor Similar mortality rates to placebo at 1 month; increased 6-month mortality Higher rate of serious infections Not effective; poses a risk of serious infections
N-acetylcysteine (NAC) Antioxidants Some promise shown in combination with steroids Dry mouth, nausea, vomiting Encouraging data; further studies needed
Rifaximin Antibiotic with low systemic absorption; targeting gut–liver axis; reduces endotoxin levels Decreased endotoxin levels and hepatic venous pressure gradient; trend toward benefit in small pilot study Generally well tolerated with low systemic absorption Positive effects on liver hemodynamics; pilot study
Betaine Antioxidant and methionine metabolite Improvement in hepatic steatosis in case reports Diarrhea, nausea Needs further study
Granulocytapheresis Removes activated granulocytes and monocytes No benefit in case series of severe AH patients Well tolerated without hemodynamic compromise No clinical benefit observed

AH = alcohol-associated hepatitis, IgG = immunoglobulin G, LPS = lipopolysaccharide, IL1 = interleukin 1, ASK-1 = apoptosis signal regulating kinase 1, MAPK = mitogen activated protein kinase, JNK = jun N terminal kinase, FXR = farnesoid receptor X, IL-22 = interleukin 22, TNF-α = tumor necrosis factor alpha, G-CSF = granulocyte stimulating factor.