Cirrhosis is characterized by fibrosis and nodule formation of the liver secondary to chronic injury, leading to alteration of the normal lobular organization of the liver. Various insults can injure the liver, including viral infections, toxins, hereditary conditions, or autoimmune processes. With each injury, the liver forms scar tissue (fibrosis), initially without losing its function. After a chronic injury, most of the liver tissue becomes fibrotic, leading to loss of function and the development of cirrhosis.
Chronic liver diseases usually progress to cirrhosis. In the developed world, the most common causes of cirrhosis are hepatitis C virus (HCV), alcoholic liver disease, and nonalcoholic steatohepatitis (NASH), while hepatitis B virus (HBV) and HCV are the most common causes in the developing world. Other causes of cirrhosis include autoimmune hepatitis, primary biliary cholangitis, primary sclerosing cholangitis, hemochromatosis, Wilson disease, alpha-1 antitrypsin deficiency, Budd-Chiari syndrome, drug-induced liver cirrhosis, and chronic right-sided heart failure. Cryptogenic cirrhosis is defined as cirrhosis of unclear etiology.
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When clinical signs, symptoms, or abnormal liver function tests are discovered, further evaluation should be pursued promptly. The most common causes of cirrhosis are viral hepatitis, alcoholic liver disease, and nonalcoholic steatohepatitis. Initial workup includes viral hepatitis serologies, ferritin, transferrin saturation, and abdominal ultrasonography as well as complete blood count, liver function tests, and prothrombin time/international normalized ratio, if not already ordered. Additional testing is based on demographics and risk factors.
Common serum and ultrasound-based screening tests to assess fibrosis include the aspartate transaminase to platelet ratio index score, Fibrosis 4 score, FibroTest/FibroSure, nonalcoholic fatty liver fibrosis score, standard ultrasonography, and transient elastography. Generally, noninvasive tests are most useful in identifying patients with no to minimal fibrosis or advanced fibrosis.
Treatment goals are preventing cirrhosis, decompensation, and death. Varices are monitored with endoscopy and often require prophylaxis with nonselective beta-blockers. Ascites treatment includes diuresis, salt restriction, and antibiotic prophylaxis for spontaneous bacterial peritonitis when indicated. Hepatic encephalopathy is managed with lifestyle and nutritional modifications and, as needed, with lactulose and rifaximin. Hepatocellular carcinoma screening includes ultrasound screening every six months for patients with cirrhosis.
There are several unmet needs associated with hepatic cirrhosis. Obstacles to drug development in cirrhosis include intrinsic biological factors, a heterogeneous patient population, and a lack of acceptable surrogate endpoints. All these warrant the development of novel drugs that can overcome these barriers to ensure a better quality of life for patients.
The epidemiology of CLD is shifting, reflecting the implementation of large-scale hepatitis B vaccination and hepatitis C treatment programs, the increasing prevalence of metabolic syndrome, and increasing alcohol misuse. Cirrhosis prevalence and mortality have increased in recent years in 7MM.
Liver cirrhosis and its complications affect millions of patients of all ages around the globe and present treating physicians with perplexing problems, given the variety of etiologies and the critical nature of hepatic physiology. Due to the restrictions of liver transplantation, complication-guided pharmacological therapy has become the mainstay of long-term management of cirrhosis.
Extensive research and development activities of pharmaceutical companies, along with the expected launch of approved therapies, will fuel the growth of the market during the forecast period, i.e., 2018–2030.
Cirrhosis isn't curable, but it’s treatable. The goals of treatment are to slow the progression of scar tissue in the liver and to prevent or treat symptoms and complications of cirrhosis. Alcohol abuse, hepatitis, and fatty liver disease are some of the main causes. The doctor will personalize the treatment based on what is the cause of cirrhosis, and the amount of liver damage you have.
The liver breaks down and removes toxins from the body including alcohol. Too much alcohol makes it hard for the liver to process it. Therefore one must abstain from it. This can be hard to do, especially if one has become dependent on alcohol. One can join support programmes, one on one counselling, inpatient rehab programmes, prescription medicines like naltrexone (Revia, Vivitrol) and acamprosate (Campral).
NASH is nonalcoholic steatohepatitis which is a non-alcoholic fatty liver disease (NAFLD). It can cause liver scarring and lead to cirrhosis. While there is no medication to reverse the fatty buildup, controlling the conditions that may contribute to it can help stop the liver damage. In some cases, liver damage has been known to reverse itself. The doctor may suggest vitamin E or pioglitazone help. Vitamin E alone is often prescribed for people who have NASH and don't have diabetes or cirrhosis.
Hepatitis B and C viruses cause liver damage that can lead to cirrhosis. Treatments for these diseases can help prevent liver damage. For hepatitis C, there are now antiviral treatments that lead to a cure in the vast majority of people. Options include antiviral drugs, Interferon (interferon-alpha 2b, pegylated interferon).
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Non-Alcoholic Fatty Liver Disease is a buildup of fat that damages the liver. This is due to being overweight or obese. The way to combat this cause of liver damage is to lose weight with diet and exercise. With any liver disease, it is important to not drink alcohol and, in some cases, avoid taking vitamin E. Find out how you can reverse or control the non-alcoholic fatty liver disease.
Cirrhosis can damage the liver to the point where it no longer works. This is called liver failure. A transplant means the damaged liver is replaced with a healthy one from a donor. It can help live longer, but it's a major surgery that comes with risks like bleeding and infection. After surgery, one needs to take medicines to prevent the body from rejecting the new organ. Because these drugs suppress the immune system, they can increase the risk of infection.
There are several drugs in the pipeline. These include Belapectin by Galectin Therapeutics, Cellgram LC by Pharmicell, MGL3196 by Madrigal, Seladelpar by CymaBay Therapeutics, Nitoxanide by Genfit among others. Companies all over the globe are persistently working towards the development of new treatment therapies and the key players at the global level are Galectin Therapeutics, Pharmicell, Madrigal, CymaBay Therapeutics, Galmed Pharmaceuticals among others.
Reimbursement may be referred to as the negotiation of a price between a manufacturer and payer that allows the manufacturer access to the market. It is provided to reduce the high costs and make the essential drugs affordable. Health technology assessment (HTA) plays an important role in reimbursement decision-making and recommending the use of a drug. These recommendations vary widely throughout the seven major markets, even for the same drug.
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