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World J Hepatol. Apr 27, 2010; 2(4): 139-142
Published online Apr 27, 2010. doi: 10.4254/wjh.v2.i4.139
Combination drug treatment in patients with non-alcoholic fatty liver disease
Theodosios D Filippatos, Moses S Elisaf
Theodosios D Filippatos, Moses S Elisaf, Department of Internal Medicine, University of Ioannina, Ioannina 45110, Greece
Author contributions: Filippatos TD prepared and wrote the editorial; Elisaf MS made corrections and did the final editing of the manuscript.
Correspondence to: Moses S Elisaf, MD, FRSH, FASA, FISA, Professor of Medicine, Department of Internal Medicine, School of Medicine, University of Ioannina, Ioannina 45110, Greece. egepi@cc.uoi.gr
Telephone: +30-2651-007509 Fax: +30-2651-007016
Received: September 1, 2009
Revised: March 24, 2010
Accepted: March 31, 2010
Published online: April 27, 2010

Non-alcoholic fatty liver disease (NAFLD) includes simple steatosis, a benign condition, and non-alcoholic steatohepatitis, a condition that beyond TG accumulation also includes necroinflammation and fibrosis. An association between NAFLD and cardiovascular disease (CVD) has been recently suggested. NAFLD patients usually have an increased CVD risk profile. NAFLD is also associated with metabolic syndrome (MetS) and is considered as the hepatic component of MetS by some authors. Currently, the only established treatment of NAFLD is gradual weight loss. However, multifactorial treatment of NAFLD risk factors may be needed to reduce the increased CVD risk of NALFD patients. Drug combinations that include antiobesity drugs (such as orlistat and sibutramine) and target CVD risk factors may be a good approach to NAFLD patients. Our group has investigated the orlistat-fenofibrate combination treatment in obese patients with MetS and the orlistat-ezetimibe and sibutramine-antihypertensive combination treatment in obese patients with hyperlipidaemia with promising results in CVD risk factor reduction and improvement of liver function tests. Small studies give promising results but double-blind, randomized trials examining the effects of such multifactorial treatment in hard CVD endpoints in NAFLD patients are missing.

Keywords: Non-alcoholic fatty liver disease, Non-alcoholic steatohepatitis, Treatment, Orlistat, Sibutramine, Fenofibrate, Ezetimibe, Weight loss