Nonalcoholic Fatty Liver Disease: A Drug Revolution Is Coming

• Main Author: Soung Won Jeong
• Format: Article
• Language: English
• Published: Korean Diabetes Association 2020-10-01
• Series: Diabetes & Metabolism Journal
• Subjects: drug therapy, combination; fibrosis; non-alcoholic fatty liver disease; precision medicine; therapeutics
• Online Access: http://www.e-dmj.org/upload/pdf/dmj-2020-0115.pdf

The worldwide prevalence of non-alcoholic fatty liver disease is around 25%, and that of nonalcoholic steatohepatitis (NASH) ranges from 1.5% to 6.45%. Patients with NASH, especially those with fibrosis, are at higher risk for adverse outcomes such as cirrhosis and liver-related mortality. Although vitamin E, pioglitazone, and liraglutide improved liver histology in randomized trials, there are currently no Food and Drug Administration-approved drugs for NASH. Five pharmacologic agents—obeticholic acid, elafibranor, cenicriviroc, resmetirom, and aramchol—are being evaluated in large, histology-based phase 3 trials. Within 2 to 4 years, new and effective drugs for the treatment of NASH are expected. Additionally, many phase 2 trials are ongoing for various agents. Based on the results of phase 2 and 3 trials, combination treatments are also being investigated. Future treatment strategies will comprise drug combinations and precision medicine based on the different phenotypes of NASH and treatment response of the individual patient.