Table 3.
Randomized double-blinded placebo-controlled trials on drug treatment in adult patients with NAFLD with liver-related outcomes, as assessed by either liver histology or magnetic resonance methods, with >20 participants in the intervention arm.
| Class | Cohort, Ref. Method Duration |
Intervention | Primary outcome | Steatosis Inflammation Fibrosis |
Metabolic effects |
|---|---|---|---|---|---|
| PPARγ agonist | NASH [185] Histology, MRS 6 m |
PIO 45 mg/d (26) PLC (21) |
NR | ↓ B/I ↓ ↔ |
OGTT/[3H]glu/[14C] glu: Glu clearance ↑, Liver ↑, Adipose ↑ Adiponectin ↑, BW ↑ TG ↓ |
| NASH [183] Histology 96 w |
PIO 30 mg/d (80) PLC (83) |
NASH histology | ↓ B/I ↔/↓ ↔ |
HOMA-IR ↓ BW ↑ HDL ↑ |
|
| NASH [186] Histology, MRS 18 m (+open 18 m) |
PIO 45 mg/d (50) PLC (51) |
NAS ↓ >2 points without F worsening a | ↓ B/I ↓, NAS ↓ ↔,% F improv. ↑ |
Clamp: Rd ↑, Liver ↑, Adipose ↑ Adiponectin ↑, BW ↑ TG ↓, HDL ↑ |
|
| NASH [184] Histology 12 m |
PIO 30 mg/d (31 of 37) PLC (30 of 37) |
Hepatocyte injury (B) + F a | ↔ B/I ↓/↔ ↓ |
HOMA-IR ↓ TG ↔ |
|
| PPARα/δ agonist | NASH [189] Histology 52 w |
ELA 80 mg/d (93) ELA 120 mg/d (91) PLC (92) |
NASH resolution without F worsening b | ↔ ↓ ELA 120 mg:↓, ELA 80 mg: ↔ |
ELA 80 mg HOMA-IR ↔ ELA 120 mg HOMA-IR ↓ Both: LDL ↓, TG ↓ |
| SGLT2i | 79% NAFLD [11] MRS/MRI 24 w |
EMPA 25 mg/d (42) PLC (42) |
LFC a | ↓ NA NA |
Clamp/[2H]glu: M ↔, Liver ↔, Adipose ↔ Adiponectin ↑ Lipids ↔ |
| NR [196] MRS 24 w |
DAPA 10 mg/d (38 of 91) PLC (42 of 91) |
BW a Substudy: LFC b |
↔ NA NA |
Adiponectin ↔ Lipids NA |
|
| NAFLD [195] MRI 12 w |
DAPA 10 mg/d (21) Om3FA g/d (20) COMB (22) PLC (21) |
PDFF b | PDFF: DAPA ↔, Om3FA ↔, COMB ↓ NA NA |
HOMA-IR: DAPA ↓, Adipo-IR ↔ Adiponectin ↔ Lipids ↔ |
|
| 73% NAFLD [197] MRS 24 w |
CANA 300 mg/d (26) PLC (30) |
LFC b | ↔ NA NA |
Clamp/[2H]glu: Rd ↔, Liver ↑, Adipose ↔ Lipids NR |
|
| GLP-1 RA | NASH [12] Histology 48 w |
LIRA 1.8 mg /d (23 of 26) PLC (22 of 26) |
NASH resolution without F worsening a | ↔, % S improv. ↑ B/I ↔, NAS ↔ % F worsening ↓ |
HOMA-IR ↔, Adipo-IR ↔ HDL ↓ |
| NR [204] MRS 26 w |
LIRA 1.8 mg/d (24) PLC (26) |
Myocardial function a Substudy: LFC b |
↔ NA NA |
Ins-S NA Lipids ↔ |
|
| DPP-4i | NAFLD [209] MRI/MRS/MRE 24 w |
SITA 100 mg/d (25) PLC (25) |
PDFF b | ↔ NA NA |
HOMA-IR ↔ Lipids ↔ |
| NR [215] MRI 6 m |
VILDA 100 mg/d (22) PLC (22) |
INS-S b PDFF a |
↓ NA NA |
Clamp/[2H]glu: M/I ↔, Liver ↔ Lipids ↔ |
|
| Metformin | NAFLD [217] Histology (CT) 24 w |
MET 2.5/3.0 g/d (20 of 24) PLC (24) |
S b | ↔, % S improv. ↓ NA NA |
HOMA-IR ↔ Adiponectin ↔ LDL ↓ |
| FXR agonist | NASH [226] Histology 72 w |
OBCA 25 mg/d (141) PLC (142) |
NAS ↓ >2 points without F worsening a | ↓ B/I ↓ ↓ |
HOMA-IR ↑ LDL ↑, HDL ↓, TG ↔ |
| NASH [225] Histology 18 m (ongoing) |
OBCA 10 mg/d (312) OCA 25 mg/d (308) PLC (311) |
F improv. (≥1 stage) without NASH worsening a NASH resolution without F worsening b |
↓ B/I ↓ ↓ |
NA | |
| CCR 2/5 antagonist | NASH [228] Histology 2 years (arm A) 1 year (arm B) |
Arm A CVC 150 mg/d (145) Arm B PLC 1st year then CVC 150 mg/d (72) Arm C PLC (72) |
NAS ↓ >2 points with B/I ↓ ≥1 point without F worsening a | ↔ ↓ ↓ |
↔ |
| SCD1 inhibitor | NASH [229] Histology/MRS 52 w |
Aram 400 mg/d (101) Aram 600 mg/d (98) PLC (48) |
LFC a/b | Aram 400 ↓, Aram 600 ↔ Aram 400 ↔, Aram 600 ↓ ↔ |
HbA1c ↓ Ins-S NA Lipids NA |
| ACC ½ inhibitor | NAFLD [230] MRI/ MRE 12 w |
GS-0976 5 mg/d (51) GS-0976 20 mg/d (49) PLC (26) |
Safety a | GS-0976 20 ↓, GS-0976 5 ↔ NA NA |
HbA1c ↔ Ins-S NA LDL ↔, HDL ↔, TG ↑ |
| THR-β agonist | NASH [235] Histology/ MRI 36 w |
Res 80 mg/d (78 of 84) PLC (38 of 41) |
PDFF a | ↓ NAS ↔ ↓ |
Ins-S NA LDL ↓, HDL ↔, TG ↓ |
| MPC inhibitor | NASH [237] Histology 12 m |
MSDC-0602K 62.5 mg/d (99) MSDC-0602K 125 mg/d (98) MSDC-0602K 250 mg/d (101) PLC (94) |
NAS ↓ >2 points with B/I ↓ ≥1 point without F worsening b | MSDC-0602K 62.5 +125 ↔, MSDC-0602K 250 ↓ B/I ↔, MSDC-0602K 62.5 +125 NAS ↓, MSDC-0602K 250 NAS ↔ ↔ |
|
| FGF21 agonist | NASH [238] MRI 16 w |
Peg 10 mg/d (25) Peg 20 mg/w (24) PLC (26) |
Safety a PDFF a |
↓ NA NA |
INS-S NA Adiponektin ↑ Lipids NR |
ACC: acetyl coenzyme A carboxylase, Aram: aramchol, B: ballooning, BW: body weight, CANA: canagliflozin, COMB: combination, CCR: chemokine receptors, d: daily, CVC: cenicriviroc, DAPA: dapagliflozin, DM: diabetes mellitus, DPP-4i: dipeptidyl peptidase-4 inhibitors, ELA: elafibranor, EMPA: empagliflozin, FGF: fibroblast growth factor, FXR: farnesoid receptor X, GLP-1RA: glucagon-like peptide 1 receptor agonists, HbA1c: glycaeted haemoglobin, eHDL: high density lipoprotein, HOMA-IR: homeostatic model of assessment of insulin resistance, improv.: improvement, INS-S: insulin sensitivity, KHK: ketohexokinase, LDL: low density lipoprotein, LFC: liver fat content, LIRA: liraglutide, M, M/I, Rd, glu clearance = whole body (muscle) insulin sensitivity, m: months, MET: metformin, mg: miligrams, MRE: magnetic resonance elastography, MRI: magnetic resonance imaging, MRS: magnetic resonance spectroscopy, NAFLD: non-alcoholic fatty liver disease, NASH: non-alcoholic steatohepatitis, NA: not assessed, NR: not reported, OBCA: obeticholic acid, OGTT: oral glucose tolerance test, Om3FA: omega 3 fatty acids, Peg: pegbelfermin, PIO: pioglitazone, PLC: placebo, PDFF: protein density fat fraction, PPAR: peroxisome proliferator activated receptor, Res: resmetirom, Ref: references, SCD: stearoyl CoA desaturase, SGLT2i: sodium glucose co-transporter 2 inhibitor, SITA: sitagliptin, TG: triglycerides, THR: thyroid hormone receptor, VILDA: vildagliptin, w: weeks.
Primary outcome measure achieved.
Primary outcome measure not achieved.