Background: Non-alcoholic fatty liver disease (NAFLD) affects a large proportion of the
general population. The disease ranges from simple steatosis, to non-alcoholic steatohepatitis (NASH),
cirrhosis and even hepatocellular carcinoma. Several drugs are used in daily clinical practice to manage
the disease. However, data on their efficacy in liver histology are not consistent.
Aim: We discuss current treatment options for NAFLD and NASH and preliminary results from novel
drugs under investigation.
Results: Among various drugs assessed for the management of NAFLD and NASH, only pioglitazone
and vitamin E have provided consistent benefits on liver histology, and are recommended by the European
and American guidelines. Statins were shown to produce clinically meaningful results in patients
with NAFLD or NASH. Other drugs such as metformin and polyunsaturated fatty acids that are being
used in clinical practice off-label have provided benefits on terms of hepatic biochemical and diabetesrelated
markers; data on liver histology with these drugs are scarce and from small studies. Several new
approaches to reduce inflammation, steatosis or fibrosis have shown promising results in experimental
models of NAFLD or NASH lesions and are being evaluated in humans.
Conclusion: Pioglitazone and vitamin E are the only drugs providing consistent benefits and are currently
recommended for NASH. Various pathogenetic pathways are being targeted to reduce steatosis,
inflammation and fibrosis and early data on several novel drugs are very promising. On-going human
trials will unveil their true impact.