Emerging role of obeticholic acid in the management of nonalcoholic fatty liver disease

Core Tip

Core tip: Nonalcoholic fatty liver disease (NAFLD) is the commonest chronic liver disease in Western countries, can progress to cirrhosis and is associated with increased all-cause and cardiovascular disease mortality risk. Current pharmacological treatment of NAFLD has limited efficacy and therefore, there is a pressing need to develop more effective and safe agents for this common and life-threatening disease. Obeticholic acid (OCA), a selective agonist of the farnesoid X receptors, might be a useful agent in the management of NAFLD. In the Farnesoid X Receptor Ligand Obeticholic Acid in non-alcoholic steatohepatitis (NASH) Treatment (FLINT) trial in patients with NASH, OCA administration was associated with improvements in liver histology, while weight loss and reduction in blood pressure were also observed. Although its adverse effects on the lipid profile and insulin sensitivity are worrisome, given the increased cardiovascular risk of this population, OCA might be considered in selected patients with NAFLD/NASH, particularly in those with adequately controlled glucose and lipid levels.