IDDF2019-ABS-0251 The efficacy of ursodeoxycholic acid in the treatment of non-alcoholic steatohepatitis: A 15-year systematic review

Abstract

Background Non-alcoholic Fatty Liver (NAFLD) is one of the most common forms of chronic liver disease which may progress to non-alcoholic steatohepatitis (NASH) and eventually develop cirrhosis or liver cancer. Currently, there are no proven therapeutic strategies for such disease. Only healthy lifestyle modification through diet and exercise are proven to afford some benefits. Consequently, most clinical efforts have been directed at treating the components of Metabolic Syndrome. Other pharmacologic interventions are directed at specific pathways potentially involved in the pathogenesis of NAFLD or NASH, e.g., insulin resistance, oxidative stress, pro-inflammatory cytokines, apoptosis, bacterial overgrowth and angiotensin pathways. However, since the FLINT study, the largest NASH Study to date, no drug ever came close to Obeticholic Acid. (ObA), except Ursodeoxycholic acid (UDCA). This systematic review of over 1548 randomized controlled trials (RCTs) from 2004–2018 shows the promising use of UDCA as a therapeutic option for NASH. Methods Over 1548 RCTs on the use of UDCA as the treatment for NASH, from 2004 to 2018 have been reviewed. Estimation of the total subject populations in all these studies approximates almost 15,000 NASH patients. Outcome measures include both decreases in liver transaminases and improvement in histology. All the RCTs, even the current guidelines, offer different options, including the use of UDCA. Follow-up periods range from 4 weeks to 96 weeks. Results Of all the 1548 RCTs reviewed from 2004–2018, 15% showed no beneficial effects with the use of UDCA while 85% of RCTs showed decreasing transaminases and improvement in histology. Conclusions UDCA, through its Farsenoid Targeting mechanism, may yet become a frontline therapeutic option for NASH, thereby preventing its progression to cirrhosis and liver cancer.