An Update on Management of Nonalcoholic Fatty Liver Disease & Nonalcoholic Steatohepapititis is the Time Ripe for Achieving Resolution of NAFLD & NASH Soon

Abstract

We earlier reviewed how obesity has assumed an endemic/pandemicproportions that has resulted in escalating incidence and prevalence ofassociated escalating worldwide incidence of Metabolic Syndrome (MetS)with non alcoholic fatty liver disease (NAFLD), that is correlated withenhanced morbidity. Later we tried to detail how probiotics, L-Carnitine(LC), Nicotinamide Ribose (NR) Combination, along with Apical SodiumDependent Bile Acids Transporter (ASBT) or Volixibat and Silybin,Vitamin D, Allyl Isothiocyanate (AITC), might aid in treating andunderstand the etiopathogenesis of NAFLD. The prevalence of NAFLDall over the world is approximately 25%, with that of non alcoholicsteatohepapititis (NASH), varying from 1.5%=6.45%. Particularly NASH,specifically the ones associated with fibrosis possess a greater chance ofgeneration of side effects that include progression to cirrhosis as well asliver-associated mortality. Despite an improvement was observed withvitamin E, Pioglitazone. liraglutide in histological appearance in liverrandomized controlled clinical trials (RCT), at present no drugs existsthat have received FDI approval for NASH. The aim of this review wasto update the newer drugs getting evaluated, undergoing phase 2-3 trials.Currently there are Obeticholic acid, elafibranor, cenicriviroc, resmetriom,in addition to aramchol, that are the five agents that are getting analysedin big, histology dependent phase 3 trials. Hopefully within another 2-4years, newer, efficacious drugs will be available for the therapy of NASH.Besides that a lot of phase 2 trials are continuing for different drugs.Further depending on outcomes of phase 2-3 trials, combination treatmentsare getting evaluated. For future therapeutic approaches would be madeup of variations in NASH phenotypes, besides personalized approachesbased on various NASH phenotypes in addition to response of every singlepatient. Further recently there were reports of utilization of curcumin withnonselective beta blocker for regression from cirrhosis (reviewed by us).Hopefully once there are approved therapies for NAFLD/NASH, we canwork in that direction.