Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 14, 2017; 23(42): 7495-7504
Published online Nov 14, 2017. doi: 10.3748/wjg.v23.i42.7495
Current and emerging pharmacological therapy for non-alcoholic fatty liver disease
Ahad Eshraghian
Ahad Eshraghian, Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz 71937-11351, Iran
Author contributions: Eshraghian A was contributed to study design, data retraction, review of articles, drafting of the manuscript, revising it and approval.
Conflict-of-interest statement: No conflict of interest to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Ahad Eshraghian, MD, Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz 71937-11351, Iran. eshraghiana@yahoo.com
Telephone: +98-71-36281442 Fax: +98-71-36281442
Received: June 7, 2017
Peer-review started: June 8, 2017
First decision: July 13, 2017
Revised: September 14, 2017
Accepted: September 19, 2017
Article in press: September 19, 2017
Published online: November 14, 2017

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.

Keywords: Non-alcoholic fatty liver disease, Non-alcoholic steatohepatitis, Vitamin E, Pioglitazone, Pharmacological therapy, Obeticholic acid

Core tip: Non-alcoholic fatty liver disease (NAFLD) is an increasing liver disease worldwide. However, most of patients are treated with life style modification including weight loss and dietary regimen. Pharmacologic therapy may be indicated in a group of patients with non-alcoholic steatohepatitis. Here in, the current and emerging medications for treatment of NAFLD was reviewed briefly with regard of their beneficial effects on histological outcomes.