Breakthroughs in therapies for NASH and remaining challenges

Initially a condition that received limited recognition and whose clinical impact was controversial, nonalcoholic steatohepatitis (NASH) has become a leading cause of chronic liver disease. Although there are no approved therapies, major breakthroughs, which will be reviewed here, have paved the way for future therapeutic successes. The unmet medical need in NASH is no longer disputed, and progress in the understanding of its pathogenesis has resulted in the identification of many pharmacological targets. Key surrogate outcomes for therapeutic trials are now accepted by regulatory agencies, thus creating a path for drug registration. A set of non-invasive measurements enabled early-stage trials to be conducted expeditiously, thus providing early indications on the biological and possibly clinical actions of therapeutic candidates. This generated efficacy results for a number of highly promising compounds that are now in late-stage development. Intense research aimed at further improving the assessment of histological endpoints and in developing non-invasive predictive biomarkers is underway. This will help improve the design and feasibility of successful trials, ultimately providing patients with therapeutic options that can change the course of the disease. (C) 2022 Published by Elsevier B.V. on behalf of European Association for the Study of the Liver.

Automated summary

Nonalcoholic steatohepatitis (NASH) has become a leading cause of chronic liver disease, and the need for effective treatments is urgent. Recent breakthroughs and progress in understanding the pathogenesis have set the stage for future therapeutic successes in NASH.