Current management of non‐alcoholic steatohepatitis

Abstract

Non‐alcoholic steatohepatitis (NASH) is the most common cause of liver disease in Western populations, and its prevalence is increasing rapidly. It is part of a multisystem disease affecting other organs such as the kidneys, heart and blood vessels, and is closely associated with the components of the metabolic syndrome. Physicians managing patients with NASH should not only focus on the management of NASH, but also on associated comorbidities in individual patients. The approaches to treatment of NASH include either limiting energy surplus alone, or in combination with targeting of downstream pathways of inflammation and fibrosis. In this mini‐review, we discuss the currently available treatment options for NASH, as well as those in late‐stage clinical trials. We discuss the challenges of managing these patients with a limited number of approved therapies, as well as managing advanced‐stage patients with NASH and cirrhosis. We also discuss the specific management of comorbidities in NASH patients, in particular diabetes, hypertension, dyslipidaemia and cardiovascular diseases. Finally, we present the screening protocols for both hepatocellular carcinoma and extrahepatic malignancies in these patients.

Peroxisome Proliferator-Activated Receptors and Their Novel Ligands as Candidates for the Treatment of Non-Alcoholic Fatty Liver Disease

“…Several late-stage clinical trials are also investigating the effects of agents that target the mechanisms involved in advanced stages of NAFLD, such as inflammation (C-C chemokine receptor CCR2/CCR5 antagonist cenicriviroc), apoptosis (caspase inhibitor emricasan, apoptosis signal-regulating kinase 1 ASK1 inhibitor selonsertib), and fibrosis (galectin-3 inhibitor belapectin). Given the multiple-hit pathogenesis of NAFLD, a multifactorial approach based on combination treatments simultaneously targeting several pathways (metabolic syndrome conditions, hepatic lipid accumulation, and NASH features) should be more effective than single drug therapy [211][212][213].…”

Hepatocellular carcinoma in patients with non-alcoholic steatohepatitis – epidemiology, risk factors, clinical implications and treatment

“…This results in an increased number of cancellations on the waiting list for LTx caused by, in the first place, cancer development exceeding the Milan criteria, and secondly mortality caused by concomitant diseases. An additional factor preventing transplantation is the fact of portal vein thrombosis, occurring more often than in other types of cirrhosis, reaching 10.1%, in patients with NAFLD [ 15 , 24 , 58 - 61 ]. For these reasons, the majority of patients with HCC in the course of NAFLD have liver resection procedures, and only a small fraction of patients are eligible for LTx [ 24 , 30 ].…”

A Systematic Review of Newer Antidiabetic Agents in the Treatment of Nonalcoholic Fatty Liver Disease

“…7 With NAFLD, the liver receives a chronic supply of calories. 8 The accumulation of triglycerides and subsequent inflammation arises from this oversupply of calories. 1,2,8 The incidence and prevalence of NAFLD has been shown to increase approximately linearly with body mass index (BMI).…”

“…8 The accumulation of triglycerides and subsequent inflammation arises from this oversupply of calories. 1,2,8 The incidence and prevalence of NAFLD has been shown to increase approximately linearly with body mass index (BMI). 1 There are 1.5 billion overweight adults (BMI = 25-29.9 kg/m 2 ), with 200 million men and 300 million women being obese (BMI ≥ 30 kg/m 2 ).…”

“…2,4 Currently, the main treatment approach for early NAFLD treatment has been lifestyle modifications. 8 Exercise and caloric restriction that lead to a ≥3% weight loss has been shown to improve HS, whereas a ≥7% weight loss has been shown to improve liver histology in NAFLD patients. 1,8,9 The challenge has been that many patients who initially lose weight and initiate exercise regimens return to their baseline weight within 3 to 5 years.…”