Evidence-based decision for pharmacological management of alcoholic liver disease and alcohol dependence

Alcoholism is a major public health problem, and alcoholic liver disease (ALD) with its complications is still one of the most frequent causes of death in the Western countries. The feasibility of pharmacological treatment in alcoholism has been demonstrated by four currently approved medications, the aldehyde dehydrogenase blocker disulfiram, the gamma-hydroxybutyric acid (GHB), the opioid antagonist naltrexone (NTX), and the glutamate antagonist acamprosate (ACM). In addition, 5HT3 antagonist ondansetron, the GABAB agonist baclofen, and the anticonvulsant topiramate have shown promising results. Moreover, among the other molecules that have already been tested, pentoxifylline (PTX), in a double-blind randomized controlled trial, induce a survival benefit especially in patients with early hepatorenal syndrome, but more trials are needed. Progress in understanding the pathogenesis of AH is leading to new therapies directed to specific mechanism involved in the development of liver injury, such as anti-TNF-a therapy. Pilot studies on the use of the antitumor necrosis factor (TNF) drugs, such as infliximab, in the treatment of alcoholic steato-hepatitis (ASH) have been performed, but the use of this kind of an agent already debuted for the increase of frequency of severe infections in treated group. The therapy of patients with alcohol-related cirrhosis is mainly symptomatic and no therapies are currently available except orthotopic liver transplantation for end-stage liver disease. Independent of the stage of alcohol dependence and ALD, abstinence from alcohol is the cornerstone of management. © 2010 Springer-Verlag Berlin Heidelberg.