What role do pharmacological treatments play in the management of NAFLD, and which agents are currently recommended?

There is currently no specific drug treatment licensed for the management of NAFLD, but pharmacological treatments may be considered in secondary or tertiary care settings for adults with advanced liver fibrosis ¹.

In these settings, pioglitazone or vitamin E may be considered off-label for adults with advanced liver fibrosis, regardless of diabetes status ¹.

Pioglitazone should be prescribed with caution, considering contraindications such as heart failure, bladder cancer, and other risk factors ¹.

Vitamin E may be used in children and young people with advanced liver fibrosis in secondary or tertiary care, but only after careful assessment ¹.

Other agents like obeticholic acid have shown promise in improving histological features of NASH, including fibrosis, but are not yet standard licensed treatments ¹.

Regular retesting and monitoring of treatment effectiveness, including ELF testing, are recommended, with adjustments or discontinuation if scores rise ¹.