2018: A Liver Year In Review

The year 2018 was an exciting year in liver diseases. It saw much progress to diagnosing, treating and providing improved access to care.

Hepatitis C

There were no new treatments introduced for hepatitis C this previously killer disease is simple to cure in almost all infected patients. Instead, focus has been shifted towards public policies aimed at eliminating hepatitis C and on improving access to its curative, life-saving therapies. New York State become the first state in the nation to set up a Department of Health Hepatitis C Elimination Task Force to develop strategies to diagnose and link to care the many people in the state who are as yet undiagnosed. Barriers to treatment such as patient drug and alcohol screening and limiting which providers can prescribe curative therapies have been removed in New York State.

Non-alcoholic Fatty Liver Disease

Initially thought to be a benign disease, the importance of assessing disease severity is being disseminated to health care providers and patients. While liver biopsy had been the sole modality available to assess for degree of steatosis and fibrosis, readily available blood tests and advanced imaging techniques such as transient elastography and special MRIs are making it easier to rapidly assess and stage this condition. While diet, exercise and weight loss remain the current treatment, 2018 saw several new innovative, oral therapies being used reporting positive results in clinical trials. These results should lead to the first medications being approved by the FDA in early 2020.

Primary Liver Cancer

Once thought to have a horrible prognosis, survival from primary liver cancer is improving. 2018 saw new chemotherapeutic agents being approved for its treatment which are better tolerated and have improved efficacy. These new agents, in combination with refined radiological therapies and liver transplantation, have made this condition manageable and curable in many patients who previously were not treatment candidates.

Primary sclerosing cholangitis

For the first time, this deadly condition with no adequate approved therapies is seeing several new agents being evaluated for treatment. While it is still early in development, just the fact that there are potential therapies being considered is exciting, groundbreaking and hopefully will bring much needed relief to the many people affected with this condition.

Alcoholic Liver Disease

Here the news is not good. Alcoholic liver disease is on the rise in the United States, especially among people under the age of 30. The combination of increased alcohol use and advancement in hepatitis C treatments has made liver disease from alcohol the number one indication for liver transplantation in our country. There are no medications to reverse the effects of alcohol on the liver, only abstinence may lead to improvement. For this, we need the health care system to cover alcohol prevention programs to a greater degree and this is not happening.

While 2018 saw progress, there are still certain specific liver diseases where much work needs to be done. Hepatitis B can be suppressed but cure remains elusive and access to suppressive therapies is complicated by high cost. Autoimmune hepatitis has not seen much progress or even clinical studies with new agents making long term steroid and immunosuppressive agents the treatments of choice, despite their potential long-term side effects. For now, I would like to wish everyone a happy and a healthy New Year.

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David Bernstein
David Bernstein, MD, is a columnist for Long Island Weekly and chief of gastroenterology, hepatology and nutrition at North Shore University Hospital and Long Island Jewish Medical Center.

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