Current pharmacological therapies for nonalcoholic fatty liver disease/nonalcoholic steatohepatitis

Table 1 Mechanism of action and limitations/demerits of drugs for nonalcoholic fatty liver disease/nonalcoholic steatohepatitis

Drug	Mechanism of action	Limitations/demerits
Insulin sensitizers	Improve insulin sensitivity	Obvious side effects (heart attack with rosiglitazone; weight gain, edema, heart failure, and bone density reduction with pioglitazone)
Antioxidants (vitamin E)	Attenuate oxidative stress	Long-term safety is questionable (increased all-cause mortality and risk of prostate cancer)
Lipid-lowering drugs	Improve dyslipidemia	The efficacy has not been fully validated in clinical trials
Pentoxifylline	Inhibits synthesis of TNF-α	Randomized controlled trials led to inconsistent results. Side effects (nausea and vomiting)
UDCA	Antiapoptotic and cytoprotective properties	Most randomized controlled trials did not show positive effects
Angiotensin receptor blockers	Modulates insulin sensitivity	Randomized controlled trials are lacking. Side effects (hypotension)
n-3 PUFAs	Activate PPARα	Specific quantities and ratios of EPA and DHA are unclear in most trials
Probiotics and synbiotics	Control gut microbiota	The most effective preparation and dose have not yet been established
Herbal medicines/natural products	Anti-inflammatory and antioxidative properties	Effects have not been studied in humans

UDCA: Ursodeoxycholic acid; n-3 PUFAs: N-3 polyunsaturated fatty acids; TNF: Tumor necrosis factor; PPAR: Peroxisome proliferator-activated receptor; EPA: Eicosapentaenoic acid; DHA: Docosahexaenoic acid.