비알코올 지방간질환의 약물치료 업데이트 = Update of Pharmacological Therapy in Non-Alcoholic Fatty Liver Disease

다국어 초록 (Multilingual Abstract)

Clinical significance of nonalcoholic fatty liver disease (NAFLD) in Korea will be increasing in the near future according to the improvement of nutrition and changing dietary habits. According to 2018 practice guideline for NAFLD recently introduced by AASLD, lifestyle intervention including diet control and exercise is a mainstay of treatment for NAFLD. Although drug development for NAFLD has been delayed compared with other liver disease area, a few positive advances are being achieved in NASH patients. Pioglitazone or high dose vitamin E supplement could be used in NASH patients, but long-term safety of these medications has to be confirmed in further studies. Metformin, UDCA and omega-3 fatty acid are not recommended as a treatment of NASH, but metformin and omega-3 fatty acid could be considered as a treatment of combined diabetes or dyslipidemia in NASH patients. Recently liraglutide (GLP-1R agonist), obeticholic acid (FXR agonist), elafibranor (PPARα/δ agonist), cenicriviroc (Dual CCR2/CCR5 antagonist) and selonsertib (ASK1 inhibitor) are showing relatively promising data in clinical trials and could be good candidate for NASH treatment in the future. Bariatric surgery could be considered in NASH patients with morbid obesity or medical treatment failure, but the long-term safety and efficacy is not fully confirmed especially in cirrhotic patients.