The study of chronic
liver disease has been hampered by insufficient information relative to the pathogenesis of the many forms of
hepatitis. Consequently, well-designed treatment strategies are frequently lacking.
Wilson's disease is characterised by excessive
copper accumulation in the liver and other organs. While
d-penicillamine is clearly effective, many patients may not tolerate its many adverse effects.
Trientine, oral
zinc and
unithiol have all shown promise as therapeutic alternatives. Autoimmune
chronic active hepatitis responds well to
prednisone and
azathioprine.
Cyclosporin has also produced clinical improvement in several case reports but no comparison has yet been made with the current standard
therapy. Recombinant
interferon-alpha (IFN alpha) has demonstrated the ability to inhibit
hepatitis B viral replication, and the combination of oral
corticosteroids followed by IFN alpha is more effective than either agent alone in eliminating viral replication in patients with
chronic active hepatitis B. Currently,
primary sclerosing cholangitis (PSC) has no standard medical management, but
corticosteroids and
methotrexate may each have a future role in its treatment.
Drug treatment for
primary biliary cirrhosis (PBC) has been disappointing, and early reports of success with
d-penicillamine were not confirmed in large well-controlled trials. While some reports of improvement with several agents have been described, larger studies are still needed.
Alcoholic liver disease continues to be associated with significant morbidity and mortality and numerous investigators have researched several different medical avenues of treatment. Success reported with
androgens and the
antithyroid agent propylthiouracil in
alcoholic liver disease will need confirmation by other research before these agents can be recommended for routine use. Finally,
colchicine may prove to be effective in slowing the rate of
fibrosis in
cirrhosis, but this has yet to be conclusively proven.