Pharmacotherapy for Cirrhosis in Japan

ABSTRACT Cirrhosis is a terminal manifestation of chronic liver disease, regardless of its cause, and was previously considered an irreversible condition. As cirrhosis progresses from the compensated to the decompensated stage, liver disease‐related events such as varices, ascites, encephalopathy, sarcopenia, jaundice, and bleeding tendency, as well as liver carcinogenesis, can occur at a high rate, and the regenerative capacity of the liver eventually fails. With the advent of new pharmacotherapies for cirrhosis in the last decade, liver fibrosis has been shown to improve with appropriate intervention, and the prognosis for cirrhotic patients has improved dramatically. According to published data from the Japan Society of Hepatology, although hepatitis C virus (HCV) used to be the leading cause of cirrhosis in Japan, alcoholic hepatitis has overtaken HCV as the leading cause, and thus a major paradigm shift has occurred in this field. There are mainly two approaches to pharmacotherapy for cirrhosis: (1) eliminating the underlying cause of cirrhosis and (2) treating the cirrhosis‐related complications. This review article outlines the efficacy and clinical impact of drugs currently covered by insurance in Japan for the treatment of cirrhosis.