Non-alcoholic steatohepatitis (NASH) is an advanced form of non-alcoholic fatty liver disease (NAFLD). As NAFLD progresses through the stages, fat causes inflammation and damage to the liver, which leads to scarring. This leads to NASH, which is a severe stage of the disease.
NASH is the most common cause of liver disease in the West, yet there are no US Food and Drug Administration (FDA) approved therapeutic or pharmacological treatments to fight the disease. Without prevention, this chronic liver disease can progress to cirrhosis and hepatocellular carcinoma.
This article explores the current treatment options for NASH and how they’re expected to advance in the future.
Current NASH Treatments
Current therapies for NASH are mostly lifestyle-based and involve exercise and dieting to achieve weight loss. This is because these measures help to lower cholesterol, saturated fat levels, and fructose in the body. However, lifestyle-based treatments are difficult to sustain long-term for patients.
Pioglitazone, a medicine used to treat type 2 diabetes, can also be used to treat the disease. Yet many healthcare organizations don’t approve of this treatment because it poses the risk of cancer. This is the same for the prolonged use of vitamin E treatments.
The Future of NASH Treatments
There are several prospective drug treatments for the treatment of NASH that are in development. Some of these treatments aim to negate the effects of inflammation, fat, and fibrosis in the liver, while others focus on treating one specific element. Many focus on one element of the disease due to the complicated nature of NASH.
To determine the most promising drug treatments, it’s essential to consider those that are in phase 3 development. Some of these include:
Obeticholic Acid
Obeticholic acid is the medicine used to treat primary biliary cholangitis (PBC) – a type of liver disease that affects the bile ducts. This medicine is the furthest along in development and seems likely to receive FDA approval soon. That is to say, a 25mg dosage of obeticholic acid is proven to reduce the effects of fibrosis in NASH patients. This means it is useful in delaying or preventing cirrhosis.
For this treatment to be approved, scientists still need to figure out the specific context by which to prescribe this medicine.
Peroxisome Proliferator–Activated Receptor (PPAR) Agonist Elafibranor
Elafribranor is an experimental medication developed to treat diabetes, dyslipidemia, and insulin resistance. This medication has been shown to improve many effects of NASH – including lipid and glucose metabolism, inflammation, and fibrosis.
A study involving a dosage of 120mg over one year resolved NASH without causing fibrosis to worsen and gave patients a better cardiometabolic risk profile.
Sodium-Glucose Cotrans-Porter-2 (SGLT-2) Agonists
SGLT-2 inhibitor agonists are a class of medications that are used to lower glucose in patients with type 2 diabetes. Combination therapies involving SGLT-2 inhibitors conclude that it may be feasible to use this as a therapeutic treatment for NASH. The treatment is suitable for individuals who are unresponsive to monotherapy or treatment with other drug classes.
Research still needs to be conducted into the pathogeneses of NASH to identify specific therapeutic targets. Identifying these targets would further optimize the treatment and improve outcome results.