Pharmacologic Management of Nonalcoholic Steatohepatitis

Nonalcoholic steatohepatitis (NASH) is increasingly recognized as a major form of chronic liver disease in adults and children. Although improved dietary habits and regular exercise remain the primary recommendations for patients with or at risk of having NASH, implementing and sustaining these lifestyle changes have proven to be challenging. Pharmacologic approaches are now being evaluated to prevent the development of cirrhosis and its complications in the approximately 1% of the population of countries consuming a Western diet at risk for NASH. Although some therapies are available for the treatment of NASH, none is currently approved by the US Food and Drug Administration. Approval of new drugs for NASH is expected within the next several years. Thus, a rational approach to understanding how these drugs work is needed. This article explains how the many new therapies that are currently in clinical trials address the varied mechanisms by which patients develop NASH and NASH-induced cirrhosis.