Rifaximin-α Slows Liver Fibrosis Progression in Alcohol-Related Liver Disease

Background: Alcohol-related liver disease (ALD) is a leading cause of cirrhosis and liver-related mortality worldwide. Liver fibrosis is the key predictor of long-term outcomes in ALD, and effective antifibrotic therapies remain an unmet need, particularly for patients unable to achieve sustained abstinence. Disruption of the gut-liver axis has been implicated in fibrogenesis, with rifaximin-α, a nonabsorbable antibiotic, previously shown to improve gut-barrier function and reduce systemic inflammation in cirrhosis. Objective: To assess the efficacy and safety of rifaximin-α in reducing liver fibrosis in patients with biopsy-proven ALD without prior hepatic decompensation. Design: Single-center, double-blind, placebo-controlled, phase 2 trial (GALA-RIF) in Denmark. Methods: Adults aged 18 to 75 years with a history of alcohol overuse and histologically confirmed ALD were randomly assigned (1:1) to receive rifaximin-α 550 mg twice daily or placebo for 18 months. Primary end point was more...