Arun Sanyal, MD on Metabolic-Pathway-Targeting Medication Options for NAFLD

In this video, Arun Sanyal, MD, talks about the treatment options that are available for treating nonalcoholic fatty liver disease via metabolic pathways. He recently spoke about this topic at the 21st Annual Harvard Nutrition and Obesity Symposium on NAFLD. 

Arun Sanyal, MD, is a professor of medicine at Virginia Commonwealth University in Richmond, Virginia.


Hello, my name is Arun Sanyal, and I'm a professor of medicine at Virginia Commonwealth University.

There are no proven drug therapies for fatty liver disease. So, all treatments are currently considered off label. So that's very important to remember.

Having said that, there are many drugs in development at various stages of development. Of the drugs that are used off label, probably the best-quality data from a liver perspective is available for thiazolidines, particularly pioglitazone, where multiple studies have shown that it improves steatohepatitis and at least in some meta-analysis suggests that it might also improve fibrosis. Although, no study has individually shown significant improvement in fibrosis.

The other drugs that are available are GLP-1 receptor agonists, such as liraglutide. There's a small and randomized pilot study done in England, which suggested benefit. More recently, a larger phase 2 trial has read out positive as well, with increased resolution of steatohepatitis.

So, while these drugs are not approved for this indication, there is evidence to support their use of in an off-label manner. So those are the common drugs that have a metabolic basis.

Vitamin E is another drug, which is an antioxidant, that is also used for the treatment of NASH. It has been shown to increase the resolution of steatohepatitis, but it has not been convincingly shown to improve fibrosis.

Thank you everyone for listening to me today. I hope you enjoyed my presentation.