Fatty liver treatments promising but evidence needed

Australia & New Zealand Medical & Surgical Gastrointestinal Week 2009, Sydney

A RANGE of promising treatments are currently available for patients with non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH), an Australian expert says.

However, Dr Amany Zekry, a gastroenterologist at St George Hospital in NSW, said there was limited evidence upon which to formulate treatment advice due to a lack of suitable studies.

Speaking at the recent conference, she said available data was hampered by studies lacking randomisation or having small samples.

“There is no single medication that can be recommended for routine use in clinical practice.”

Dr Zekry said orlistat (Xenical) was a favourable treatment for weight loss in those who complied with dietary requirements, with positive effects on cholesterol and triglycerides, steatosis and liver fibrosis.

Glitazones, particularly pioglitazone (Actos), were also useful, she said, with patients randomised to pioglitazone having improved liver function tests compared to those taking placebo.

Dr Zekry warned long-term safety of glitazones was a concern, however, after a metaanalysis showed a risk of cardiovascular events in patients receiving rosiglitazone (Avandamet).

Other research showed patients receiving metformin had improved liver function and liver histology, while statins and angiotensin receptor blockers also might slow down the progression of fibrosis in patients with NAFLD, she said.