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Cited by 114Liver Disease Diagnosis and TreatmentLiver Diseases and ImmunityDrug-Induced Hepatotoxicity and Protection

Pharmacological management of nonalcoholic fatty liver disease

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Barb, Diana, Portillo-Sanchez, Paola, Cusi, Kenneth·2016·Metabolism
DOI 10.1016/j.metabol.2016.04.004
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Abstract

Nonalcoholic fatty liver disease (NAFLD) affects one-third of the population and two-thirds of patients with obesity or type 2 diabetes (T2DM). Its more aggressive form is known as nonalcoholic steatohepatitis (NASH) and is characterized by hepatocyte necrosis, inflammation and often fibrosis. The presence of fibrosis indicates a more aggressive course and may lead to cirrhosis. Premature mortality in NASH is related to both hepatic (cirrhosis and hepatocellular carcinoma) and extra-hepatic complications, largely cardiovascular disease (CVD). Many therapeutic agents have been tested, but still none approved specifically for NASH. Treatment of NAFLD includes aggressive management of diabetes and cardiovascular risk factors, although the role of controlling hyperglycemia per se in patients with T2DM and NASH remains unknown. Agents tested with some success in non-diabetic patients with NASH include pioglitazone, liraglutide, vitamin E and to a lesser degree, pentoxiphylline. In patients with T2DM and NASH only pioglitazone has shown to significantly improve liver histology, with only a handful of patients with diabetes having been studied with other modalities. This review focuses on available agents for NASH to assist clinicians in the management of these complex patients. Many novel compounds are being studied and will likely make combination therapy for NASH a reality in the future.

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  • There are no effective pharmacological therapies for NASH or NASH-mediated fibrosis.

    “As yet, however, there are no effective pharmacological therapies for NASH or NASH-mediated fibrosis 10 , stemming at least in part from the limited understanding of cellular and molecular mechanisms driving disease progression.”

    From Amphiregulin from regulatory T cells promotes liver fibrosis and insulin resistance in non-alcoholic steatohepatitis (2024) · cites this paper as [10]

    The Clinical Practice section says no medications were FDA-approved for NASH, but explicitly describes pioglitazone as safe and effective for treating it. The Thiazolidinediones section also reports improved mean fibrosis scores versus placebo, while qualifying the antifibrotic effect as suggested rather than established. The categorical claim that no effective pharmacological therapies exist therefore contradicts the paper. (LLM, conf=0.90)

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Cited by

Sorted by citations

Authors
Barb, D., Portillo-Sanchez, P., & Cusi, K.
Affiliations
University of Florida Health (US)
Corresponding author
Cusi, Kenneth
ORCID
Venue
Metabolism
Publisher
Elsevier BV
Published
2016-08
Volume
65
Issue
8
Pages
1183-1195
ISSN
0026-0495 (ISSN-L)
DOI
10.1016/j.metabol.2016.04.004
OpenAlex
W2398592169
Cited by
114
References
27
Citations by year
2026: 3 · 2025: 6 · 2024: 12 · 2023: 8 · 2022: 4 · 2021: 11 · 2020: 17 · 2019: 9 · 2018: 17 · 2017: 18 · 2016: 9
FWCI
2.39
Type
journal article
Language
en
Open access
Licence
Locations
  • Metabolism (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Epidemiology › Liver Disease Diagnosis and Treatment
  • Health Sciences › Medicine › Hepatology › Liver Diseases and Immunity
  • Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Pharmacology › Drug-Induced Hepatotoxicity and Protection
Keywords
non-alcoholic fatty liver disease, nonalcoholic steatohepatitis, pharmacotherapy, type 2 diabetes, obesity, liver fibrosis, liver cirrhosis, hepatocellular carcinoma, cardiovascular disease, pioglitazone, liraglutide, vitamin E, hyperglycemia, combination therapy
MeSH terms
Antioxidants, Cardiovascular Diseases, Diabetes Mellitus, Type 2, Humans, Hypoglycemic Agents, Risk Factors, Non-alcoholic Fatty Liver Disease

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