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1. What is non-alcoholic fatty liver?
What is non-alcoholic fatty liver? |
Fatty liver can be broadly divided into secondary fatty liver disease and non-alcoholic fatty liver disease. Secondary fatty liver is when fatty liver is caused by factors such as alcohol, drugs, and congenital, and non-alcoholic fatty liver disease is fatty liver disease caused by metabolic abnormalities. Insulin resistance causes metabolic abnormalities such as obesity, diabetes, high blood pressure, and hyperlipidemia, which can lead to non-alcoholic fatty liver and non-alcoholic steatohepatitis. Hepatic steatosis, inflammatory infiltration, and balloon deformation occur, and when this develops, it leads to hepatitis, liver fibrosis, and cirrhosis.
In recent years, both the prevalence rate and medical costs in Korea have been increasing, and the number of patients has increased by about 15 times in 10 years, and the medical cost has increased by about 18 times. It is a common disease that occurs in 5~6% of the total adult population, but most of them are asymptomatic, and it is difficult to diagnose it early. Early diagnosis is important because some patients may progress to terminal diseases such as severe steatohepatitis or liver fibrosis, and cardiovascular diseases such as diabetes and hyperlipidemia can lead to death.
How is non-alcoholic fatty liver treated?
The problem with non-alcoholic fatty liver lies in the "three absences".
First, cognitive absence.
Mainly asymptomatic, there may be a lack of awareness of the disease.
Second, the absence of non-invasive diagnostic tests.
Biopsy, which is an invasive test, is the only diagnostic test, and many people have a fear of it.
Third, the absence of therapeutic agents.
There is no officially approved drug for the treatment of non-alcoholic fatty liver.
Therefore, lifestyle modification is the best treatment. According to the 21-year practice guideline, 5~7% weight loss resulted in improvement of fatty liver, and 7~10% weight loss improved hepatitis and liver fibrosis. For healthy weight loss, you should follow a low-calorie diet with at least 500 calories less per day than usual, and at least 30 minutes of moderate-intensity exercise at least 3 times a week. You should also be as abstinent or sober as possible.
Along with the improvement of these lifestyle habits, medicines developed to solve metabolic diseases such as pioglitazone, metformin, and statins, as well as antioxidants such as vitamin E, have the potential to improve steatohepatitis. However, these drugs are not official treatments and cannot be recommended for therapeutic purposes due to the side effects of individual medications. These drugs are recommended for the treatment of steatohepatitis rather than fatty liver itself.
If you have a high level of fatty liver or hepatitis, you should see a liver specialist, and if you suspect steatohepatitis or liver fibrosis, you should first try to improve your lifestyle for at least 3~6 months to lose weight.
Are there any ongoing non-alcoholic fatty liver trials?
If there is no improvement despite the above lifestyle improvement efforts, you can participate in a drug clinical trial.
There are many attempts to develop new drugs for non-alcoholic fatty liver at home and abroad. Some drugs are already in phase 3 clinical trials. Depending on the route of dosing, there are two types. Oral medications include 'resmetirum', which is a thyroid hormone receptor, 'Ocaliva', which is involved in bile acid metabolism, and 'ranifibrino', which acts on nuclear receptors in the liver. Of these, resmetirum is currently in phase 3 clinical trials, and the FDA is reviewing it for marketing authorization, so it is possible that it will be approved for marketing in the United States as early as next year.
Non-oral injections include GLP-1 agonists semaglutide and tirzepatide. These drugs were originally used to treat obesity and diabetes, and they are expected to have a good effect on fatty liver.
There are also a wide variety of clinical trials that can be participated in in Korea, so it may be helpful for those who have not been able to resolve non-alcoholic fatty liver with lifestyle modification therapies or over-the-counter medications.
It is currently in phase 3 clinical trials, it is injectable and requires a biopsy.
It is currently in the phase 2b clinical stage, and it is an injectable drug that requires a biopsy and can be expected to improve in patients with moderate progression of fatty liver. It is injected once a week, and it also works on cirrhosis of the liver, fibrosis.
It is in phase 2b clinical stage, is injectable and requires a biopsy.
It is only applicable to early fatty liver that has not progressed to liver fibrosis.
It is in phase 2b clinical stage, is injectable and requires a biopsy.
It is in phase 2 clinical stage, it is injectable and requires a biopsy.
It is possible to conduct an experiment when liver fibrosis is about 3 stages.
Phase 3 enrollment has closed, and a Phase 4 clinical trial, a post-market investigation, is planned.
Phase 2 enrollment is closed, it is oral and requires a biopsy.
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