Alcohol-Associated Liver Disease Market Poised for 31.1% CAGR Growth as First Disease-Modifying Therapies Near Approval
Key Insights
The alcohol-associated liver disease (search) market across the 7MM was valued at USD 145 million in 2025, with the United States accounting for approximately 59% of the total market share.
No FDA-approved therapies currently exist that directly modify ALD disease progression, leaving liver transplantation as the only curative option for end-stage disease.
Bausch Health's larsucosterol, holding FDA Fast Track and Breakthrough Therapy designations, entered Phase III trials in early 2026 with topline results expected in 2028 and potential approval by early 2029.
The alcohol-associated liver disease (search) (ALD) treatment landscape is on the cusp of a major transformation, with the market projected to expand at a compound annual growth rate (CAGR) of 31.1% during the forecast period from 2026 to 2036, according to a newly published report from DelveInsight. The market, valued at USD 145 million across the seven major markets (7MM: the United States, EU4, the United Kingdom, and Japan) in 2025, is being propelled by a pipeline of mechanism-based therapies that aim to address the underlying drivers of disease rather than merely managing symptoms.
The United States dominated the ALD treatment market in 2025, representing approximately 59% of the total 7MM market share. The total number of diagnosed prevalent cases of ALD across the 7MM reached 12.1 million in 2025, with alcohol-associated steatosis accounting for the majority of stage-specific diagnosed prevalent cases in the US at approximately 3.2 million, followed by alcohol-associated steatohepatitis and alcohol-associated cirrhosis.
A Field Without Disease-Modifying Therapies
Despite the considerable clinical and socioeconomic burden associated with ALD, there are currently no FDA-approved therapies that directly modify disease progression. Existing treatment approaches largely emphasize symptom management and prevention of complications, with long-term alcohol abstinence remaining the cornerstone of treatment at every stage. In patients with severe alcohol-associated hepatitis, corticosteroids are frequently prescribed in selected cases; however, their efficacy is variable and generally confined to short-term survival benefits.
For patients with advanced ALD who fail to respond to conventional medical management, liver transplantation remains the most effective strategy for significantly improving survival. In recent years, severe acute alcoholic hepatitis has increasingly been considered an early indication for transplantation in carefully selected patients who do not respond to therapy, supported by emerging evidence demonstrating encouraging outcomes in this high-risk group.
Larsucosterol: The Frontrunner Targeting First Approval
Bausch Health's larsucosterol (DUR-928) has emerged as the most advanced candidate in the ALD pipeline. The endogenous sulfated oxysterol functions as an epigenetic regulator designed to inhibit DNA methyltransferases (DNMT1 (search), DNMT3a, and DNMT3b), thereby reducing pathological hypermethylation associated with ALD. Through its effects on inflammatory signaling, lipid metabolism, and cellular stress pathways, the therapy is intended to minimize hepatocyte damage and promote liver repair in alcoholic hepatitis.
The US FDA has awarded larsucosterol both Fast Track and Breakthrough Therapy designations, underscoring the urgent unmet need in this indication. A Phase III clinical study in severe alcoholic hepatitis was initiated in early 2026, with topline results anticipated in 2028. Based on the projected primary completion timeline of June 2028, the therapy is expected to potentially secure regulatory approval by early 2029, followed by a commercial launch later that year, which could make it the first approved treatment for this indication. In 2036, among all the therapies for ALD, the highest revenue is estimated to be generated by larsucosterol in the US.
In September 2025, Bausch Health Companies completed its tender offer to acquire DURECT Corporation, purchasing all outstanding shares for USD 1.75 per share in cash, totaling approximately USD 63 million upfront. The deal also includes up to USD 350 million in additional milestone payments tied to future net sales.
A Diversifying Pipeline of Targeted Therapies
GSK's GSK4532990 represents a novel approach to ALD treatment as an investigational RNA interference (RNAi) therapy targeting HSD17B13 (search), a gene associated with susceptibility to liver disease. By suppressing hepatic HSD17B13 expression, the therapy seeks to mimic the protective effects observed in individuals carrying loss-of-function variants, thereby helping reduce liver inflammation and injury. The candidate is being advanced under an exclusive licensing agreement with Arrowhead Pharmaceuticals and is currently in Phase II clinical evaluation for ALD. In November 2025, GSK presented results from its advancing liver pipeline, including GSK4532990, at the American Association for the Study of Liver Diseases (AASLD) The Liver Meeting 2025.
INT-787, a next-generation oral farnesoid X receptor (FXR (search)) agonist, was initially developed by Intercept Pharmaceuticals and later integrated into Alfasigma (search)'s liver disease portfolio following the company's 2023 acquisition. Through FXR activation, INT-787 is designed to regulate metabolic, inflammatory, and fibrotic processes, potentially delivering hepatoprotective effects. The candidate is presently being assessed in the Phase IIa FRESH trial for severe alcoholic hepatitis.
Altimmune's pemvidutide and Nterica (search)'s NTR-101 round out the key emerging therapies. In March 2026, Altimmune announced that the use of pemvidutide to treat ALD, including to reduce liver fibrosis, is protected under a pending US provisional patent application. If granted, the resulting patents are expected to extend protection until at least March 2047.
Market Drivers and Evolving Treatment Paradigms
Several factors are converging to drive market growth. Rising global alcohol consumption, particularly among men, remains a key contributor to the growing burden of ALD. Simultaneously, increasing alcohol use among women, who may be biologically more vulnerable to liver damage, is driving a comparatively sharper rise in ALD risk. The significant overlap between ALD and metabolic conditions such as obesity and insulin resistance is also reshaping the understanding of the disease, opening avenues for metabolic-focused treatments including GLP-1–based therapies.
Aparna Thakur, Assistant Project Manager, Forecasting at DelveInsight, noted that "small molecules continue to lead the innovation landscape, accounting for the majority of pipeline activity, while emerging modalities such as siRNA and peptide-based therapies are poised to drive future diversification in alcohol-associated liver disease (search) treatment strategies."
The anticipated launch of these emerging therapies is poised to transform the ALD market landscape. Unlike traditional reliance on corticosteroids, the pipeline now includes diverse modalities such as GLP-1/glucagon dual agonists, FXR (search) agonists, and microbiome-directed therapies, targeting upstream drivers like metabolism, inflammation, and microbial dysbiosis rather than only downstream inflammation. As these therapies continue to mature and gain regulatory approval, they are expected to offer new standards of care and unlock opportunities for medical innovation in a field that has long awaited its first disease-modifying treatment.