Drug treatments to prevent first decompensation in cirrhosis

Cirrhosis is a prevalent condition affecting more than 100 million people globally and carrying significant morbidity and mortality related to the development of portal hypertension and hepatic decompensation. Current treatment is primarily targeted at identifying chronic liver disease early and preventing the progression of fibrosis by treating the underlying etiology of liver disease. Treatment options for patients with advanced fibrosis are limited, and the only drug class approved for the prevention of hepatic decompensation remains nonselective beta-blockers. There are several pharmacological therapies being developed in both preclinical and clinical trials to explore their efficacy in preventing first hepatic decompensation. Most studies evaluate primary endpoints reflective of disease severity and portal hypertension, such as changes in HVPG or fibrosis stage based on histology or imaging. While many drugs are being investigated, much work is still needed to identify treatment targets with effective outcomes to move the needle in the field of cirrhosis management. This narrative review will address the current state of cirrhosis therapies, including potential new therapeutic targets, and provide direction on future advancements that will improve our current treatment paradigm and lead to better outcomes for those burdened with cirrhosis.