Non-alcoholic fatty liver disease medical therapy

Non-Alcoholic Fatty Liver Disease Microchapters
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Editor in Chief: Elliot Tapper, M.D., Beth Israel Deaconess Medical Center, C. Michael Gibson, M.S., M.D. [1]

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Overview

Trials are presently being conducted to optimize treatment of NASH. No standard treatment has yet emerged as the gold standard. General recommendations include improving metabolic risk factors - weight loss, treating diabetes, managing lipids - and reducing alcohol intake.

Medical Therapy

One of the largest trials of NAFLD/NASH therapy evaluated rosiglitazone, an insulin-sensitizing thiazolidinedione..Rosiglitazone for nonalcoholic steatohepatitis: one-year results of the randomized placebo-controlled Fatty Liver Improvement with Rosiglitazone Therapy (FLIRT) Trial.Gastroenterology 2008;135:100-10.</ref> This study found, after one year, no significant improvement in markers of liver injury. In May of 2010, Sanyal and colleagues published a randomized, placebo-controlled trial of Vitamin E (800 IU daily) and pioglitazone (30 mg daily) with paired-biopsies. They found that Vitamin E was best able to achieve improvement in NAFLD/NASH, vis-a-vis improvements in the histological stigmata of NASH (steatosis, lobular inflammation, ballooning degeneration and fibrosis). Pioglitazone was able to achieve significant improvements in some of the individual markers. Steatohepatitis resolved in 47% of patients taking Vitamin E and 36% taking pioglitazone. Neither medication could achieve significant improvements in fibrosis or portal inflammation.