Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz 71937-11351, Iran.
World J Gastroenterol. 2017 Nov 14;23(42):7495-7504. doi: 10.3748/wjg.v23.i42.7495.
The main treatment of patients with non-alcoholic fatty liver disease (NAFLD) is life style modification including weight reduction and dietary regimen. Majority of patients are safely treated with this management and pharmacologic interventions are not recommended. However, a subgroup of NAFLD patients with non-alcoholic steatohepatitis (NASH) who cannot achieve goals of life style modification may need pharmacological therapy. One major obstacle is measurement of histological outcome by liver biopsy which is an invasive method and is not recommended routinely in these patients. Several medications, mainly targeting baseline mechanism of NAFLD, have been investigated in clinical trials for treatment of NASH with promising results. At present, only pioglitazone acting as insulin sensitizing agent and vitamin E as an anti-oxidant have been recommended for treatment of NASH by international guidelines. Lipid lowering agents including statins and fibrates, pentoxifylline, angiotensin receptor blockers, ursodeoxycholic acid, probiotics and synbiotics are current agents with beneficial effects for treatment of NASH but have not been approved yet. Several emerging medications are in development for treatment of NASH. Obeticholic acid, liraglutide, elafibranor, cenicriviroc and aramchol have been tested in clinical trials or are completing trials. Here in, current and upcoming medications with promising results in clinical trial for treatment of NAFLD were reviewed.
非酒精性脂肪性肝病（NAFLD）患者的主要治疗方法是生活方式改变，包括减肥和饮食控制。大多数患者可通过这种方法安全治疗，不建议使用药物干预。但是，有一小部分非酒精性脂肪性肝炎（NASH）患者不能达到生活方式改变的目标，可能需要药物治疗。一个主要障碍是肝活检测量组织学结果，这是一种侵入性方法，不建议常规用于这些患者。一些药物，主要针对 NAFLD 的基本机制，已在临床试验中用于治疗 NASH，结果有一定前景。目前，只有吡格列酮作为胰岛素增敏剂和维生素 E 作为抗氧化剂被国际指南推荐用于治疗 NASH。降脂药物包括他汀类药物和贝特类药物、己酮可可碱、血管紧张素受体阻滞剂、熊去氧胆酸、益生菌和合生菌，对 NASH 的治疗有有益作用，但尚未获得批准。一些新兴药物正在开发用于治疗 NASH。奥贝胆酸、利拉鲁肽、艾拉酚胺、cenicriviroc 和阿瑞匹坦已在临床试验中进行测试或正在完成试验。本文综述了临床试验中治疗 NAFLD 有前景的现有和即将上市的药物。
