The Future Of Treating Liver Disease

Take care of your liver in 2020. (Photo by Evie Shaffer from Pexels)

2020 brings with it significant hope for advancements in liver disease across many different conditions. We will see the first medication approved for the treatment of non-alcoholic fatty liver disease. Fatty liver disease is the most common liver disease in America.

Currently, diet and exercise are the only treatments. Drug development for its treatment has been slow with most drugs failing to show efficacy or being associated with significant side effects. Obeticholic acid, however, a drug already approved for the treatment of primary biliary cholangitis, has shown promise in treating fatty liver, and will likely be approved by the FDA in late March to treat fatty liver. While this medication is not a panacea, it finally will offer hope for patients. Successful treatment of fatty liver will not come from medications alone and this new therapy must be accompanied by continued diet, exercise and control of diabetes in patients with this condition.

There is also research being done in autoimmune liver disease and we hope to see some positive results in 2020. There are numerous clinical trials with new medications treating both primary biliary cholangitis and primary sclerosing cholangitis. These should report out early clinical results and hopefully these preliminary results will lead to the expansion in research to fill the void of treatment of these conditions.

Several years ago, all the buzz in liver disease was about new treatments for chronic hepatitis Current therapies cure more than 95 percent of people with hepatitis C using affordable 8 to 12 week regimens with minimal side effects. Sadly, there is a rise in the number of new hepatitis C cases due to the opioid epidemic, especially in our youth. The challenge in 2020 is to find and treat these patients while simultaneously treating their opioid addictions. If this can be done, we can prevent the spread of hepatitis C and hopefully get back on track to eliminate this disease in the U.S. by the stated goal of 2030.

Perhaps the real need and excitement revolves around hepatitis B. More potent vaccines were recently introduced to better prevent this infection. This common condition can be treated with essentially lifelong suppressive medications, which are not curative therapy. These treatments have been shown to reverse fibrosis and to reduce but not eliminate the risk of developing liver cancer. There is now real interest in developing new therapies to not only treat but cure hepatitis B. Several new diagnostic tests are being introduced,which will allow physicians to better monitor patients for response.

2020 looks to be an exciting year in liver medicine. I hope that by this time next year, there will be many new and exciting developments to discuss that will improve the lives of people suffering from liver disease as well as their families.

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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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