Treatment of liver fibrosis: clinical aspects.
The main objective of antifibrotic treatment is to avoid the complications of chronic liver disease where its cause cannot be treated. Three main therapeutic endpoints can be targeted: cause; comorbidity; and fibrosis. Antifibrotic treatment is any intervention independent of cause that is intended to modify the course and/or level of fibrosis through direct action on the mechanisms of fibrosis. Several modalities are here considered: reduction of fibrosis course; reversion of fibrosis; and reversion of cirrhosis. Semiquantitative histological staging and morphometry are complementary techniques for monitoring fibrosis. The degree of fibrosis should preferentially be estimated by fibrosis progression based on measurements taken at baseline and during treatment, rather than by raw static measurements. Surrogate markers are the only tools for assessing drug efficacy in clinical practice, and are especially useful for checking compliance and identifying poor or non-responders. We propose to define non-response as no decrease in fibrosis progression. The renin-angiotensin system is a good candidate target for antifibrotic treatment, and angiotensin-II type-1 receptor blockers, such as sartans, are probably effective. Clinical trials are currently ongoing using marketed drugs, while new multitargeted drugs are likely to emerge from basic research.
Calès
P
P
Service d'hépatogastroentérologie, CHU, 49933 Angers cedex 09, France. paul.cales@univ-angers.fr
Boursier
J
J
Chaigneau
J
J
Oberti
F
F
Rousselet
M-C
MC
D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D002986:Clinical Trials as Topic / Q000379:methods; D003657:Decision Making; D003952:Diagnostic Imaging; D018450:Disease Progression; D006801:Humans; D006820:Hyaluronic Acid / Q000378:metabolism; D008103:Liver Cirrhosis / Q000209:etiology / Q000473:pathology / Q000628:therapy*; D008111:Liver Function Tests
D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D006820:Hyaluronic Acid