Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Nov 27, 2018; 10(11): 790-794
Published online Nov 27, 2018. doi: 10.4254/wjh.v10.i11.790
Treating nonalcoholic steatohepatitis with antidiabetic drugs: Will GLP-1 agonists end the struggle?
Maria Kalogirou, Emmanouil Sinakos
Maria Kalogirou, Emmanouil Sinakos, 4th Department of Internal Medicine, Hippocrates Hospital, Aristotle University of Thessaloniki, Thessaloniki 54642, Greece
Author contributions: Kalogirou M and Sinakos E conceived the study and drafted the manuscript; both authors approved the final version of the article.
Conflict-of-interest statement: Emmanouil Sinakos reports personal fees from Novo Nordisk, outside the submitted work.
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: Emmanouil Sinakos, MD, PhD, Assistant Professor, 4th Department of Internal Medicine, Hippocrates Hospital, Aristotle University of Thessaloniki, 49, Konstantinopoleos Street, Thessaloniki 54642, Greece. esinakos@auth.gr
Telephone: +30-69-44912668 Fax: +30-23-10992940
Received: July 31, 2018
Peer-review started: July 31, 2018
First decision: August 20, 2018
Revised: September 10, 2018
Accepted: October 9, 2018
Article in press: October 10, 2018
Published online: November 27, 2018

Nonalcoholic fatty liver disease (NAFLD) is highly associated with insulin resistance (IR), type 2 diabetes mellitus and metabolic syndrome, being characterized as the hepatic component of metabolic syndrome. Despite its high prevalence, no pharmacological treatment has been established, as of yet. A growing body of evidence, however, shows that reducing IR can result in improvement of the biochemical and histological features of nonalcoholic steatohepatitis (NASH)-the aggressive form of NAFLD that can lead to cirrhosis and hepatocellular carcinoma. Unfortunately, the several trials that have assessed the effect of various antidiabetic agents to date have failed to establish an effective and safe treatment regimen for patients with NAFLD. Glucagon-like peptide-1 (commonly known as GLP-1) agonists are a novel class of antidiabetic drugs that improve insulin sensitivity and promote weight loss. They also appear to have a direct effect on the lipid metabolism of hepatocytes, reducing hepatic steatosis. Several trials have demonstrated that GLP-1 agonists can reduce aminotransferase levels and improve liver histology in patients with NAFLD, suggesting that these agents could serve as an alternative treatment option for these patients. This manuscript discusses the role and potential mechanisms of GLP-1 agonists in the treatment of NASH.

Keywords: Nonalcoholic steatohepatitis, Cirrhosis, Glucagon-like peptide-1 receptor agonists, Nonalcoholic fatty liver disease

Core tip: There is an urgent need for an effective treatment of nonalcoholic fatty liver disease (NAFLD). Growing evidence indicates that reducing insulin resistance can result in improvement of the biochemical and histological features of patients with nonalcoholic steatohepatitis (NASH). However, no antidiabetic agent to date has been proven as both safe and effective for the treatment of patients with NASH. Recent studies have demonstrated that glucagon-like peptide-1 agonists, a novel class of antidiabetic drugs, may be effective in slowing the progression of NAFLD, highlighting their potential role in the treatment of this complex disease.