A Paradigm Shift in Nonalcoholic Fatty Liver Disease Management

Non-alcoholic liver disease (NAFLD) is the most common cause of liver disease in the United States and is associated with significant morbidity and mortality once NALFD progresses to non-alcoholic steatohepatitis (NASH). NASH is predicted to become the main indication for liver transplant in the United States as obesity rates continue to rise. Currently, management of NAFLD is limited to lifestyle modifications with pharmacotherapy gaps. Once NAFLD has progressed to NASH, the use of off-label medications including thiazolidines and vitamin E can be considered. However, in recent years, GLP-1 (Glucagon-like peptide 1) agonists and SGLT-2 (Sodium-glucose cotransporter-2) antagonists have demonstrated efficacy in reversing hepatosteatosis and fibrosis in several studies in NAFLD and early NASH. Additionally, several novel agents are in phase III clinical studies for the treatment of NASH. The scope of treatment of NAFLD and NASH is likely to change dramatically in the next decade as the burden of disease increases.