Roy Partho Pratik, Mahtab Mamun Al, Rahim Mohammad Abdur, Yesmin Sm Sabrina, Islam Sunan Bin, Akbar Sheikh Mohammad Fazle
Departmant of Anatomy, Shaheed Suhrawardi Medical College, Dhaka, Bangladesh.
Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.
Euroasian J Hepatogastroenterol. 2022 Jul;12(Suppl 1):S46-S50. doi: 10.5005/jp-journals-10018-1360.
Nonalcoholic fatty liver disease (NAFLD) is one of the major and prevalent liver diseases from the national and global perspectives. It appears that considerable numbers of the general population have been suffering from NAFLD. When a patient with NAFLD also exhibits inflammation of the liver, the condition is regarded as nonalcoholic steatohepatitis (NASH). Nonalcoholic steatohepatitis is a pathological entity that may progress to cirrhosis of the liver (LC) and hepatocellular carcinoma (HCC). It is acceptable by all that the health burden of NAFLD and NASH is tremendous. Due to the increased prevalence of these pathologies, extensive research has been conducted regarding pathogenesis, diagnostic tools, and staging of the diseases. However, adequate and approved pharmacotherapy for these pathologies is lacking. The farnesoid receptor (FXR) is a bile acid-activated receptor. It regulates lipid, glucose, bile acid metabolism. Farnesoid receptor is also endowed with anti-inflammatory and anti-fibrotic properties on the liver. Obeticholic acid (OCA), a potent and selective FXR ligand, may become a promising molecule to combat NASH and advanced fibrosis. The present review briefly discusses the current recommendation of NASH management with available pharmacological treatments. The scope of OCA with a focus on recent data of major randomized controlled trials (RCTs) is discussed. On the basis of current data and recent interim analysis, OCA seems to improve insulin resistance, steatohepatitis, levels of alanine transaminase (ALT) and fibrosis in NASH. Dose-related adverse effects like pruritus and dyslipidemia may limit its usage. Also, its usage may be restricted in patients with NASH cirrhosis. More adequately powered RCTs that would contain NASH patients with different and heterogeneous properties would be required to develop consensus about these issues. The safety profile of different doses of OCA needs to be established in these patients as well as there remain considerable queries about these.
Roy PP, Mahtab MA, Rahim MA, . Treatment of Nonalcoholic Steatohepatitis by Obeticholic Acid: Current Status. Euroasian J Hepato-Gastroenterol 2022;12(Suppl 1):S46-S50.
从国家和全球角度来看，非酒精性脂肪性肝病（NAFLD）是主要的常见肝脏疾病之一。似乎相当多的普通人群都患有NAFLD。当NAFLD患者还出现肝脏炎症时，这种情况被视为非酒精性脂肪性肝炎（NASH）。非酒精性脂肪性肝炎是一种可能进展为肝硬化（LC）和肝细胞癌（HCC）的病理实体。所有人都认可NAFLD和NASH的健康负担极其巨大。由于这些疾病的患病率不断上升，人们对其发病机制、诊断工具和疾病分期进行了广泛研究。然而，针对这些疾病缺乏充分且获批的药物治疗方法。法尼酯X受体（FXR）是一种胆汁酸激活受体。它调节脂质、葡萄糖和胆汁酸代谢。法尼酯X受体还具有肝脏抗炎和抗纤维化特性。奥贝胆酸（OCA）是一种强效且选择性的FXR配体，可能成为对抗NASH和晚期纤维化的有前景的分子。本综述简要讨论了当前关于NASH管理的现有药物治疗建议。讨论了以主要随机对照试验（RCT）的最新数据为重点的奥贝胆酸的应用范围。根据当前数据和近期中期分析，奥贝胆酸似乎可改善NASH患者的胰岛素抵抗、脂肪性肝炎、丙氨酸转氨酶（ALT）水平和纤维化。瘙痒和血脂异常等剂量相关不良反应可能会限制其使用。此外，其在NASH肝硬化患者中的使用可能会受到限制。需要开展更有足够效力的RCT，纳入具有不同和异质性特征的NASH患者，以就这些问题达成共识。还需要确定不同剂量奥贝胆酸在这些患者中的安全性概况，因为关于这些问题仍有相当多疑问。
Roy PP, Mahtab MA, Rahim MA, 。奥贝胆酸治疗非酒精性脂肪性肝炎：现状。《欧亚肝脏胃肠病学杂志》2022年；12（增刊1）：S46 - S50。
