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Nonalcoholic fatty liver disease: new treatments.

Hardy T, Anstee QM, Day CP - Curr. Opin. Gastroenterol. (2015)

Bottom Line: Nonalcoholic steatohepatitis (NASH) is a particular health concern due to the increased morbidity and mortality associated with progressive disease.Vitamin E may improve histology in NASH, but safety issues limit its use.Comorbidities must be diagnosed and treated; cardiovascular disease remains a primary cause of death in these patients.

View Article: PubMed Central - PubMed

Affiliation: Liver Research Group, Institute of Cellular Medicine, The Medical School, Newcastle University, Newcastle-Upon-Tyne, UK.

ABSTRACT

Purpose of review: Nonalcoholic fatty liver disease is the most common cause of liver dysfunction in the western world because of its close association with obesity, insulin resistance and dyslipidaemia. Nonalcoholic steatohepatitis (NASH) is a particular health concern due to the increased morbidity and mortality associated with progressive disease. At present, without specific targeted pharmacological therapies, the mainstay of therapy remains weight loss through dietary modification and lifestyle change; thus, the purpose of this review is to summarize the recent evidence for current and emerging therapies in NASH.

Recent findings: Some existing medications, including pioglitazones and angiotensin receptor antagonists, may be repurposed to help treat this condition. Vitamin E may improve histology in NASH, but safety issues limit its use. Recently, a number of novel agents specifically targeting nonalcoholic fatty liver disease pathogenesis have entered clinical trials, including the farnesoid X receptor agonist obeticholic acid, which has shown significant histological improvements in steatohepatitis and fibrosis.

Summary: Diet/lifestyle modification remains the mainstay of treatment. For patients with NASH and advanced fibrosis, current liver-directed pharmacotherapy with vitamin E and pioglitazone offer some benefits; obeticholic acid appears promising and is currently being tested. Comorbidities must be diagnosed and treated; cardiovascular disease remains a primary cause of death in these patients.

No MeSH data available.


Related in: MedlinePlus

Evidence-based schematic for treatment of nonalcoholic steatohepatitis using currently available agents.
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Figure 1: Evidence-based schematic for treatment of nonalcoholic steatohepatitis using currently available agents.

Mentions: Despite its prevalence and rising incidence, NAFLD is marked by substantial interpatient variability in prognosis and continues to lack the breadth of therapeutic research and development shared by other causes of chronic liver disease. Although major advances have been made in understanding pathogenesis and also identification of genetic modifiers of liver injury extending beyond simple steatosis including PNPLA3 and TM6SF2[81,107,108▪▪], these advances have not yet been fully capitalized upon and so we lack effective pharmacotherapy. Diet and lifestyle modification remain the mainstay of treatment. For patients with NASH and advanced fibrosis, current liver-directed pharmacotherapy with vitamin E and pioglitazone offer some benefits in selected cases. Figure 1 provides a schematic of treatment, once the diagnosis of NASH has been made. However, the beneficial effects of these therapies must be balanced with the potential adverse effects, limiting their widespread use. Coexisting comorbidity must be diagnosed and treated because CVD remains primary cause of death in these patients. The new agents currently in trial provide the first hope of effective, targeted pharmacotherapy in this field.


Nonalcoholic fatty liver disease: new treatments.

Hardy T, Anstee QM, Day CP - Curr. Opin. Gastroenterol. (2015)

Evidence-based schematic for treatment of nonalcoholic steatohepatitis using currently available agents.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4482455&req=5

Figure 1: Evidence-based schematic for treatment of nonalcoholic steatohepatitis using currently available agents.
Mentions: Despite its prevalence and rising incidence, NAFLD is marked by substantial interpatient variability in prognosis and continues to lack the breadth of therapeutic research and development shared by other causes of chronic liver disease. Although major advances have been made in understanding pathogenesis and also identification of genetic modifiers of liver injury extending beyond simple steatosis including PNPLA3 and TM6SF2[81,107,108▪▪], these advances have not yet been fully capitalized upon and so we lack effective pharmacotherapy. Diet and lifestyle modification remain the mainstay of treatment. For patients with NASH and advanced fibrosis, current liver-directed pharmacotherapy with vitamin E and pioglitazone offer some benefits in selected cases. Figure 1 provides a schematic of treatment, once the diagnosis of NASH has been made. However, the beneficial effects of these therapies must be balanced with the potential adverse effects, limiting their widespread use. Coexisting comorbidity must be diagnosed and treated because CVD remains primary cause of death in these patients. The new agents currently in trial provide the first hope of effective, targeted pharmacotherapy in this field.

Bottom Line: Nonalcoholic steatohepatitis (NASH) is a particular health concern due to the increased morbidity and mortality associated with progressive disease.Vitamin E may improve histology in NASH, but safety issues limit its use.Comorbidities must be diagnosed and treated; cardiovascular disease remains a primary cause of death in these patients.

View Article: PubMed Central - PubMed

Affiliation: Liver Research Group, Institute of Cellular Medicine, The Medical School, Newcastle University, Newcastle-Upon-Tyne, UK.

ABSTRACT

Purpose of review: Nonalcoholic fatty liver disease is the most common cause of liver dysfunction in the western world because of its close association with obesity, insulin resistance and dyslipidaemia. Nonalcoholic steatohepatitis (NASH) is a particular health concern due to the increased morbidity and mortality associated with progressive disease. At present, without specific targeted pharmacological therapies, the mainstay of therapy remains weight loss through dietary modification and lifestyle change; thus, the purpose of this review is to summarize the recent evidence for current and emerging therapies in NASH.

Recent findings: Some existing medications, including pioglitazones and angiotensin receptor antagonists, may be repurposed to help treat this condition. Vitamin E may improve histology in NASH, but safety issues limit its use. Recently, a number of novel agents specifically targeting nonalcoholic fatty liver disease pathogenesis have entered clinical trials, including the farnesoid X receptor agonist obeticholic acid, which has shown significant histological improvements in steatohepatitis and fibrosis.

Summary: Diet/lifestyle modification remains the mainstay of treatment. For patients with NASH and advanced fibrosis, current liver-directed pharmacotherapy with vitamin E and pioglitazone offer some benefits; obeticholic acid appears promising and is currently being tested. Comorbidities must be diagnosed and treated; cardiovascular disease remains a primary cause of death in these patients.

No MeSH data available.


Related in: MedlinePlus