Review article: current and emerging therapies for acute alcohol‐associated hepatitis

Summary Background Alcohol‐associated hepatitis is an acute manifestation of alcohol‐associated liver disease (ALD) and is associated with 30%–40% mortality at 28 days. Abstinence and corticosteroids are the mainstays of treatment, but the latter only improves short‐term mortality, so new and improved therapies remain an unmet need. Aims The aim was to review the pathophysiology of alcohol‐associated hepatitis and how various targets can be used by current and emerging therapies as treatment. Methods A thorough literature review was conducted on acute alcohol‐associated hepatitis, current therapies and therapies under investigation. Results With the increasing prevalence of alcohol use disorder and ALD, the burden of alcohol‐associated hepatitis is also expected to rise. The current understanding of alcohol‐associated hepatitis pathophysiology has led to clinical trials of several therapies involving IL‐1 antagonism, modification of the gut microbiome and liver regeneration. Conclusions Corticosteroid therapy for alcohol‐associated hepatitis is restricted in its applicability and has limited efficacy. Developing multidisciplinary, patient‐centred care models based on digital health technologies, in combination with continued discovery of novel therapies using multiomics data and computational biology techniques will be necessary to tackle the increasing burden of alcohol‐associated hepatitis. Several mechanisms result in the acute manifestation of alcohol‐associated hepatitis in patients with alcohol‐associated liver disease. Therapies targeting these mechanisms, as well as emerging discoveries in research techniques, pharmacotherapy, and care paradigms are reviewed.