Hormonal
FXR agonists (e.g., obeticholic acid) improve MASH histology but are limited by side effects like pruritus and increased LDL cholesterol.
FXR agonists like obeticholic acid can improve liver scarring and inflammation in MASH. However, they often cause severe itching and can raise bad cholesterol (LDL). They are not first-line treatments and require careful monitoring for side effects.
The prototype for this class of compounds is obeticholic acid (OCA), which has been extensively investigated and shown to significantly improve the histological features of MASH, although it can cause side effects such as pruritus and increased low-density lipoprotein (LDL) cholesterol.
Why this rating
Extensively investigated in phase 3 trials with clear histological benefits, though regulatory hurdles exist due to side effects.
Source
Pipeline of New Drug Treatment for Non-alcoholic Fatty Liver Disease/Metabolic Dysfunction-associated Steatotic Liver Disease
Ye Hu et al. · Journal of Clinical and Translational Hepatology · 2024
DOI 10.14218/jcth.2024.00123
More from this paper
- GLP-1 receptor agonists (e.g., semaglutide, liraglutide) and dual/triple incretin agonists (e.g., tirzepatide, retatrutide) significantly reduce hepatic steatosis and liver enzymes in patients with MASLD, primarily through indirect mechanisms of weight loss and improved insulin resistance, though they may not consistently resolve fibrosis.Good
- SGLT2 inhibitors reduce hepatic lipid content and liver enzymes in patients with MASLD and Type 2 Diabetes, but histological evidence for treating MASH is still required.Moderate
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