From the Guidelines
The most effective treatment for liver cirrhosis involves a multifaceted approach, including addressing the underlying cause, managing complications, and supporting liver function, with the first-line treatment for patients with cirrhosis and ascites consisting of sodium restriction and diuretics, such as oral spironolactone with or without oral furosemide, as recommended by the 2009 Hepatology study 1. The treatment strategy depends on the cause and severity of cirrhosis. For patients with an alcohol component to their liver injury, abstaining from alcohol consumption is crucial 1. Key considerations in managing liver cirrhosis include:
- Addressing the underlying cause: alcohol cessation for alcoholic cirrhosis, antiviral medications like entecavir or tenofovir for hepatitis B, as supported by the 2016 Journal of Hepatology study 1, or direct-acting antivirals for hepatitis C.
- Nutritional support: a balanced diet with 1.2-1.5g/kg of protein daily and sodium restriction to <2g/day if ascites is present.
- Managing complications:
- Ascites: diuretics like spironolactone and furosemide 1.
- Varices: beta-blockers such as propranolol or nadolol.
- Hepatic encephalopathy: lactulose.
- Advanced cirrhosis may require liver transplantation evaluation, with considerations for viral replication, HCC, and hepatitis B immunoglobulin monoprophylaxis as risk factors for HBV recurrence post-transplantation 1. Regular monitoring of liver function, screening for hepatocellular carcinoma, and vaccination against hepatitis A and B are essential components of ongoing care, aiming to improve outcomes by slowing the progression of cirrhosis.
From the FDA Drug Label
The overall SVR12 was 93% (38/41). SVR12 was similar based upon prior HCV treatment history and cirrhosis status SVR12 rates were 94% (63/67) in subjects with cirrhosis and 98% (46/47) in subjects who were previously treated and had cirrhosis SOLAR-1 and SOLAR-2 were two open-label trials that evaluated 12 and 24 weeks of treatment with ledipasvir and sofosbuvir tablets (90 mg/400 mg) in combination with ribavirin in HCV treatment-naïve and previously treated adult subjects with genotype 1 and 4 infection who had undergone liver transplantation and/or who had decompensated liver disease.
- Ledipasvir and sofosbuvir can be used to treat liver cirrhosis caused by HCV genotype 1 or 4.
- The SVR12 rate for subjects with cirrhosis was 94%.
- The treatment regimen includes ledipasvir and sofosbuvir tablets in combination with ribavirin for 12 weeks.
- The results of the SOLAR-1 and SOLAR-2 trials support the use of ledipasvir and sofosbuvir in subjects with decompensated liver disease 2.
From the Research
Liver Cirrhosis Treatment
Liver cirrhosis is a condition characterized by the scarring of liver tissue, leading to impaired liver function. The treatment of liver cirrhosis involves managing the underlying cause of the condition, as well as preventing and treating any complications that may arise.
Causes and Risk Factors
The most common causes of cirrhosis include:
- Alcohol use disorder
- Nonalcoholic fatty liver disease
- Hepatitis C
- Viral hepatitis
- Autoimmune diseases
- Cholestatic diseases
- Iron or copper overload 3, 4, 5, 6
Diagnosis and Management
Cirrhosis can be diagnosed through a combination of physical examination, laboratory tests, and imaging studies, such as ultrasonography and transient elastography. Liver biopsy remains the reference standard for diagnosis 3, 4, 5. The management of liver cirrhosis involves:
- Counseling patients about alcohol use, obesity management, and prevention of infection
- Avoiding drugs with potential hepatotoxicity
- Clinical assessment with laboratory tests and calculation of the Child-Pugh and Model for End-stage Liver Disease (MELD) scores every 6 months
- Evaluating for and managing cirrhosis-related complications, such as hepatocellular carcinoma, ascites, spontaneous bacterial peritonitis, hepatic encephalopathy, and esophageal varices 3, 4, 5
Treatment Options
Treatment options for liver cirrhosis include:
- Nonselective β-blockers, such as carvedilol or propranolol, to prevent variceal bleeding
- Lactulose for hepatic encephalopathy
- Combination aldosterone antagonists and loop diuretics for ascites
- Terlipressin for hepatorenal syndrome
- Antiviral drugs, such as tenofovir and entecavir, for hepatitis B virus-related cirrhosis 4, 7
- Liver transplantation for patients with a MELD score of 15 or greater, complications of cirrhosis, or hepatocellular carcinoma 3
Complications and Prognosis
Cirrhosis can lead to a range of complications, including:
- Hepatocellular carcinoma
- Ascites
- Spontaneous bacterial peritonitis
- Hepatic encephalopathy
- Esophageal varices The prognosis for patients with cirrhosis varies depending on the underlying cause and the presence of complications. The 5-year cumulative rate of liver decompensation, hepatocellular carcinoma, and cirrhosis-related complications can be as high as 3.1%, 1.9%, and 2.1%, respectively 7.