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Sitagliptin has been reported to be neutral [62] or to on blood markers of hepatic fibrosis and serum
decrease plasma aminotransferases, although their aminotransferase levels.
overall impact on liver histology is unknown.
(viii)Atorvastatin
(v)Sodium–glucose cotransporter 2 (SGLT2) inhibitors
Pilot studies found a benefit from atorvastatin on
A reduction in intrahepatic triacylglycerol aminotransferase levels in patients with NAFLD.
accumulation would be expected from a decrease
in substrate supply to the liver by the combined (ix)Pentoxifylline
effects of normoglycaemia plus modest weight loss Pentoxifylline inhibits production of tumor necrosis
and enhanced insulin sensitivity. In animal models factor-alpha, which has been hypothesized to
of NASH, sodium–glucose cotransporter 2 (SGLT2) contribute to the progression of NASH. Pentoxifylline
inhibitors like canagliflozin, have unique antifibrotic was associated with improvements in steatosis,
properties. lobular inflammation, and liver fibrosis scores.

b.Other pharmacologic therapies (x)Omega-3 fatty acids

(i)Orlistat Studies have suggested a benefit of omega-3 fatty
acids in animals and humans with NAFLD or NASH.
Orlistat is a gastrointestinal lipase inhibitor used in
the treatment of obesity and type 2 diabetes mellitus.
Orlistat is used when needed as an adjunct for weight c.Future treatments for patients with NASH
loss, but not as a primary treatment for NASH. Therapeutic agent Proposed mode of action

BMS986036 Improvement of hepatic lipid
(ii)Ursodeoxycholic acid and glucose metabolism; anti-
Ursodeoxycholic acid (UDCA) may have antiapoptotic inflammatory
and antiinflammatory effects in the liver.
Cenicriviroc Inhibition of CCR2- and
CCR5-mediated monocyte/
(iii)Obeticholic acid macrophage infiltration and
Obeticholic acid is a synthetic variant of the bile acid inflammation
chenodeoxycholic acid and is a potent activate of Elafibranor Stimulation of NEFA
the farnesoid X nuclear receptor. It promotes insulin oxidation; improvement of
sensitivity and decreases hepatic gluconeogenesis lipid and glucose metabolism;
and circulating triglycerides. prevention of inflammation
Emricasan Inhibition of fibrosis by blocking
(iv)Aramchol
caspase protease activation
Aramchol is a fatty acid (arachidic acid)-bile acid and apoptosis pathways
(cholic acid) conjugate. It acts by inhibiting stearoyl- GR-MD-02 Prevention of inflammation
coenzyme A desaturase, an enzyme that modulates and fibrosis
fatty acid metabolism in the liver.
Px-104 Regulation of hepatic glucose
(v)Probucol and lipid metabolism
Probucol is a lipid-lowering agent with antioxidant Simtuzumab Inhibition of fibrosis by a
properties. Studies show a larger change in alanine LOXL2 monoclonal antibody
aminotransferase level than patients in the control
group. (vi)Betaine Summary And Recommendations
1.Weight loss is the only therapy with sufficient
Betaine is a normal component of the metabolic cycle
of methionine and has a protective effect against evidence suggesting it is beneficial and safe. In
steatosis in animal models. Showed favorable results addition to its other health benefits, weight loss, either
in a pilot study. through lifestyle modifications or bariatric surgery,
has been associated with histologic improvement in
patients with NAFLD. A reasonable goal for many
(vii)Losartan
patients is to lose 0.5 to 1 kg/week (1 to 2 lb/week).
A pilot study of the angiotensin II receptor antagonist
losartan in patients with NASH suggested a benefit 2.Patients with NAFLD, require vaccinations for

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