Alcoholic liver disease
Spectrum of liver injury in patients with chronic alcohol use, ranging from steatosis to acute alcoholic hepatitis and cirrhosis.
ICD-10 K704 drugs
Also known as: ALD, Alcoholic hepatitis
Marketing claims without evidence base
The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.
- DAdemetionineNot recommended · Amino acids and derivatives. Hepatoprotective agentA 2006 Cochrane review of S-adenosyl-L-methionine in alcoholic liver disease concluded that evidence is insufficient to recommend it; the 2015 update was withdrawn. EASL 2018 and AASLD 2019 alcoholic liver disease guidelines are built on complete alcohol cessation and, in severe alcoholic hepatitis, corticosteroids (prednisolone) per Maddrey score. Ademetionine is not recommended in these documents.
- DEssential phospholipidsNot recommended · Liver therapy (local classification)Essential phospholipids (soybean-derived) are promoted as a hepatoprotector to restore liver cells, including in alcoholic liver disease. No convincing benefit has been shown for this indication: good-quality RCTs and systematic reviews do not confirm any effect on disease course or outcomes. What helps in alcohol-related liver disease is, above all, stopping alcohol, along with correcting nutrition and deficiencies; in severe cases a doctor decides on additional treatment per guidelines. The substance itself is harmless in this role, but it should not be taken instead of an approach with proven benefit, since that delays treatment that actually works.
- DSilymarin (Silybum marianum)Not recommended · Plant antioxidant from milk thistle fruits; IV silibinin is an antidote in Amanita phalloides poisoningCochrane 2017 reviewed 18 randomised trials in 1088 patients with alcoholic or viral liver disease: milk thistle did not reduce all-cause mortality, cirrhosis complications or improve liver histology. EASL and AASLD do not recommend silymarin for alcoholic liver disease. The evidence-based intervention is full alcohol abstinence; in severe hepatitis, systemic glucocorticoids by the Maddrey score apply. Alcohol dependence is best addressed through programmes (psychotherapy, naltrexone, acamprosate), not a milk thistle course.
- FGlycyrrhizic acid + phospholipidsNot recommended · Liver therapy (local classification, «hepatoprotectors»)For alcoholic liver disease, EASL 2018 recommends complete alcohol cessation and, in severe alcoholic hepatitis, prednisolone per Maddrey. Hepatoprotectors are not part of the recommendations.
How to read tiers A–F
Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.
- AStrong evidence – first or second line in international guidelines
- BRecommended in selected cases
- CStudy data contradict each other
- DBenefit not proven, no documented harm
- FDocumented harm, or risk without benefit