Table 2.
Effects of CLD therapies on portal hypertension regression
| Drug/substance | Drug/substance class | Effect on HVPG | Other effects | |
|---|---|---|---|---|
| Beneficial effect on HVPG | Statins | Simvastatin [74–77, 79] | ↓, ↘ | ↓ mortality, ↑ IGC |
| Renin–angiotensin–aldosterone system antagonists | ARBs/ACEIs/AAs [82–84] | ↘ | Renal effects, ↓ MAP (CPS B and C), reduction in fibrosis progression | |
| Galectin 3 inhibitor | Belapectin [98] | ↘ (study without BL EV) | Prevention of de novo EV, ↓ hepatocyte ballooning | |
| FXR agonist | Obeticholic acid [100] | ↘ | ||
| Rho-kinase inhibitor | Fasudil [89] | ↘ | ↓ SVR, ↓ MAP | |
| Multikinase inhibitor | Sorafenib [101] | ↘ | ↓ VEGF, PDGF, PlGF, RhoA and TNFα mRNA levels | |
| Probiotic | VSL#3 [103–105] | ≈/↘ |
↑ serum Na2 + , ↓ plasma TNFα levels ↑ NSBB response rate |
|
| Essential amino acid | Taurine [102] | ↘ | ||
| PDE-5 inhibitors | Udenafil [86] | ↓ | ||
| Vardenafil [85] | ↓ | |||
| Sildenafil [87, 88] | ≈ (↓ HVR and ↑PBF) | ↓ MAP | ||
| Antioxidants | Dark chocolate [106] | ↓ Attenuation of postprandial HVPG increase | ↑ MAP | |
| Ascorbic acid [107] | ↓ Attenuation of postprandial HVPG increase | |||
| Endothelin receptor antagonists | BQ-123 (ETA)—intrahepatic administration [94] | ↓ | ||
| Ambrisentan (ETA) [94] | ↓ | ↓ MAP | ||
| No effect on HVPG | Endothelin receptor antagonists | Tezosentan [91] (dual ETA & ETB) | ≈ | |
| BQ-123 (ETA) [92] | ≈ | ↓ MAP, ↓ SVR | ||
| BQ-788 (ETB) [92] | ≈ | ↑ MAP, ↑ SVR | ||
| LOXL2 inhibitor | Simtuzumab [108–110] | ≈ | ||
| Pan-caspase inhibitor | Emricasan [112, 113] | ≈ | ||
| Tetrahydrobiopterin analog | Sapropterin [96] | ≈ | ||
| Relaxin-2 analog | Serelaxin [97] | ≈ (trial stopped prematurely) | ||
| Antibiotics | Norfloxacin [114–116, 121] | ≈ | ↑ MAP, ↑ SVR | |
| Rifaximin [117–120] | Undetermined | ↓ inflammation and bacterial translocation serum markers additive effect to b-blocker therapy |
Treatment strategies are classified according to their effect on HVPG (beneficial effect—acute/chronic hemodynamic response—or no effect) and the number/size of the existing studies; ↓ = acute hemodynamic response; ↘ = chronic hemodynamic response; ≈ = no effect on HVPG; MAP mean arterial pressure, SVR systemic vascular resistance, HVR hepatic vascular resistance, PBF portal blood flow, IGC indocyanine green clearance, EV esophageal varices, BL baseline