Current efforts and trends in the treatment of NASH.
Of all the aspects of non-alcoholic fatty liver disease (NAFLD), the slowest advances have occurred in the therapeutic field. Thirty-five years after its formal description and after 15 years of intense scrutiny from researchers worldwide, there is still no approved drug for the treatment of non-alcoholic steatohepatits (NASH). In the meantime, progress in the understanding of pathophysiology, diagnosis - both invasive and non-invasive, epidemiology and even natural history have been substantial or, at times, spectacular. In contrast, hepatitis C virus (HCV) therapy underwent constant improvement and even before the great acceleration of the past few years, patients were already being offered approved therapies that were increasingly more efficient. What then explains such a slow pace of therapeutic advances in NASH, and will this change in the near future? Here we will review commonly-held myths that have diverted attention from therapy of NASH, obstacles that have slowed down industrial development of drugs for this indication, and recent achievements that will create better conditions for drug development programs. We will also briefly review current knowledge of non-pharmacological and pharmacological management in this early era of NASH therapies.
Université Pierre et Marie Curie, ICAN - Institute for Cardiometabolism and Nutrition, Hôpital Pitié Salpêtrière, Paris, France. Electronic address: vlad.ratziu@upmc.fr.
Vlad
V
Ratziu
Center for Liver Diseases, Inova Fairfax Hospital, 3300 Gallows Road, Falls Church, VA 22042, USA.
Zachary
Z
Goodman
Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, VA, USA.
Arun
A
Sanyal
D004032:Diet; D055808:Drug Discovery; D015444:Exercise; D006801:Humans; D008019:Life Style; D065626:Non-alcoholic Fatty Liver Disease / Q000188:drug therapy*
Antifibrotic agents; Drug development; Endpoints; Insulin sensitizers; NASH; Treatment