Hepatology
Liver Transplantation 2023 | Status report, current and future challenges
29 Jun, 2023 | 13:50h | UTC
RCT | Bulevirtide reduces HDV RNA and ALT levels in chronic hepatitis D patients
28 Jun, 2023 | 13:20h | UTCSummary: This randomized phase 3 trial evaluated the efficacy of bulevirtide, an inhibitor of HDV entry into hepatocytes, in patients with chronic hepatitis D. Patients were randomized to receive either 2 mg or 10 mg of bulevirtide daily for 144 weeks, or no treatment for 48 weeks followed by 10 mg bulevirtide daily for 96 weeks. The study involved 150 patients, 49 in the 2-mg group, 50 in the 10-mg group, and 51 in the control group.
After 48 weeks of treatment, 45% and 48% of patients in the 2-mg and 10-mg groups respectively achieved the primary end point of undetectable HDV RNA level or a decrease of at least 2 log10 IU per milliliter from baseline, and normalization of ALT level. Only 2% in the control group reached the primary endpoint. ALT levels normalized in 51% and 56% of patients in the 2-mg and 10-mg groups respectively, a significant difference from the 12% normalization in the control group. Notably, loss of HBsAg did not occur by week 48 in the bulevirtide groups. No serious adverse events related to the treatment were reported, though side effects including headache, pruritus, and fatigue were more common in the bulevirtide groups.
These results demonstrate the effectiveness of bulevirtide in reducing HDV RNA and ALT levels in patients with chronic hepatitis D. However, the absence of HBsAg loss in bulevirtide groups raises questions about its long-term implications.
Article: A Phase 3, Randomized Trial of Bulevirtide in Chronic Hepatitis D – New England Journal of Medicine (link to abstract – $ for full-text)
Commentary on Twitter
Presented today at #EASLCongress: In a randomized trial, 48 weeks of treatment with bulevirtide, which inhibits hepatitis D virus entry into hepatocytes, reduced HDV RNA and alanine aminotransferase levels in patients with chronic hepatitis D. https://t.co/Q8RNZFbQlQ
— NEJM (@NEJM) June 22, 2023
EASL Clinical Practice Guidelines on acute-on-chronic liver failure
27 Jun, 2023 | 14:00h | UTCEASL Clinical Practice Guidelines on acute-on-chronic liver failure – Journal of Hepatology
Commentary on Twitter
📢NEW@EASLnews Clinical Practice Guidelines on acute-on-chronic liver failure
Available here: https://t.co/GCNg1AIX9X pic.twitter.com/aKd0DUJBkL
— Journal of Hepatology (@JHepatology) June 24, 2023
Review | Update in the treatment of the complications of cirrhosis
21 Jun, 2023 | 13:20h | UTCUpdate in the Treatment of the Complications of Cirrhosis – Clinical Gastroenterology and Hepatology
Podcast | Inpatient cirrhosis management
20 Jun, 2023 | 12:30h | UTC# 398:Live! From SHM: Inpatient Cirrhosis Management – The Curbsiders
Cohort Study | Alcohol consumption and risks of more than 200 diseases in Chinese men
16 Jun, 2023 | 13:55h | UTCAlcohol consumption and risks of more than 200 diseases in Chinese men – Nature Medicine
News Release: Alcohol consumption increases the risks of over 60 diseases – University of Oxford
M-A | Comparing non-invasive tests, histology for predicting non-alcoholic fatty liver outcomes
15 Jun, 2023 | 14:50h | UTC
M-A | Significant non-alcoholic fatty liver disease prevalence in South Asia, many non-obese affected
6 Jun, 2023 | 14:00h | UTC
AASLD-IDSA Guideline | Updated 2023 recommendations for the testing, management, and treatment of Hepatitis C virus infection
1 Jun, 2023 | 12:21h | UTC
Guidelines | Management of ascites in liver disease
31 May, 2023 | 14:08h | UTC
AASLD practice guidance on prevention, diagnosis, and treatment of hepatocellular carcinoma
30 May, 2023 | 11:51h | UTC
Liver cystic echinococcosis: a parasitic review
25 May, 2023 | 11:19h | UTCLiver cystic echinococcosis: a parasitic review – Therapeutic Advances in Infectious Disease
RCT | Prophylactic antibiotics show no statistically significant survival improvement in severe alcohol-related hepatitis
15 May, 2023 | 13:21h | UTCSummary: This multicenter, randomized, double-blind clinical trial aimed to determine the efficacy of amoxicillin-clavulanate combined with prednisolone compared to placebo combined with prednisolone on mortality in patients hospitalized with severe alcohol-related hepatitis. The study involved 284 patients from 25 centers in France and Belgium with biopsy-proven severe alcohol-related hepatitis, who were followed up for 180 days.
The primary outcome was all-cause mortality at 60 days, while secondary outcomes included mortality at 90 and 180 days, infection rates, hepatorenal syndrome, and changes in Model for End-stage Liver Disease (MELD) and Lille scores. The results showed no statistically significant difference in 60-day mortality between the two groups, with 17.3% in the amoxicillin-clavulanate group and 21.3% in the placebo group. However, infection rates at 60 days were significantly lower in the amoxicillin-clavulanate group compared to the placebo group.
It is worth noting that the study may have been underpowered, as the absolute risk difference of 4% did not achieve statistical significance. In conclusion, the combination of amoxicillin-clavulanate and prednisolone did not show a statistically significant improvement in 2-month survival in patients hospitalized with severe alcohol-related hepatitis compared to prednisolone alone. These findings do not support the use of prophylactic antibiotics to improve survival in this patient population, but the potential underpowered nature of the study should be considered.
Article: Effect of Prophylactic Antibiotics on Mortality in Severe Alcohol-Related Hepatitis: A Randomized Clinical Trial – JAMA (link to abstract – $ for full-text)
Commentary on Twitter
Among patients with severe alcohol-related #hepatitis receiving prednisolone, amoxicillin-clavulanate did not improve survival at 60-day follow-up compared with placebo. https://t.co/4XkVL2CTsP #DDW pic.twitter.com/9sh5vennkK
— JAMA (@JAMA_current) May 9, 2023
Review | Heart failure and liver disease: cardiohepatic interactions
15 May, 2023 | 13:06h | UTCHeart Failure and Liver Disease: Cardiohepatic Interactions – JACC: Heart Failure
Review | Nonalcoholic fatty liver disease from a primary care perspective
15 May, 2023 | 12:57h | UTCNonalcoholic fatty liver disease from a primary care perspective – Diabetes, Obesity and Metabolism
Recent advances in the management of primary sclerosing cholangitis
11 May, 2023 | 11:45h | UTCRelated:
AASLD Practice Guidance on Primary Sclerosing Cholangitis and Cholangiocarcinoma – Hepatology
A consensus integrated care pathway for patients with primary biliary cholangitis.
Biliary Endoscopy in the Management of Primary Sclerosing Cholangitis and its Complications
Review | Diagnosis and management of cirrhosis and its complications
10 May, 2023 | 16:06h | UTCDiagnosis and Management of Cirrhosis and Its Complications: A Review – JAMA (free for a limited period)
Author Interview: Management of Cirrhosis in 2023
Review | The global burden of liver disease
5 May, 2023 | 15:23h | UTCThe Global Burden of Liver Disease – Clinical Gastroenterology and Hepatology
Review | Carvedilol as the new non-selective beta-blocker of choice in patients with cirrhosis and portal hypertension
4 May, 2023 | 13:36h | UTC
RCT | High vs. low target mean arterial pressure in patients with cirrhosis and septic shock
3 May, 2023 | 15:01h | UTC
Review | New treatment paradigms in primary biliary cholangitis
26 Apr, 2023 | 13:49h | UTCNew Treatment Paradigms in Primary Biliary Cholangitis – Clinical Gastroenterology and Hepatology
Perspective | Liver transplantation for patients with severe acute on chronic liver failure: it is time to change paradigms
25 Apr, 2023 | 14:37h | UTC
Commentary on Twitter
Liver #Tx in severe acute on chronic failure
➡️ #ICU care crucial in ACLF-3
➡️ improve referrals to LT centers & pre-LT workup
➡️ to decide to put pt on waitlist consider donor shortage/collective utility of LT
➡️ identifying transplantability window
🖇️ https://t.co/VZxDyZ1k74 pic.twitter.com/6YOcd5rzMu— Intensive Care Medicine (@yourICM) April 19, 2023
RCT | Bariatric–metabolic surgery is more effective than lifestyle intervention plus best medical care in non-alcoholic steatohepatitis
24 Apr, 2023 | 14:03h | UTCNews Release: Surgery most effective treatment of metabolic liver disease – King’s College London
Commentary on Twitter
New @TheLancet – Verrastro et al – Bariatric–metabolic surgery versus lifestyle intervention plus best medical care in non-alcoholic steatohepatitis (BRAVES): a multicentre, open-label, randomised trialhttps://t.co/pCWahvbReQ#NASH #NAFLD #fattyliver #livertwitter pic.twitter.com/xNMsAskJF9
— The Lancet Gastroenterology & Hepatology (@LancetGastroHep) April 21, 2023
Guideline | Management of psychiatric disorders in patients with hepatic and gastrointestinal diseases
19 Apr, 2023 | 13:07h | UTC
Guideline | Intrahepatic cholestasis of pregnancy
18 Apr, 2023 | 13:24h | UTCIntrahepatic cholestasis of pregnancy – BJOG