High expectations placed on: weight loss miracle drug "grabs the beach" for non-alcoholic fatty liver disease

  Recently, GLP-1 drugs, which have become popular due to the "magic effect" of weight loss, also show great potential in NASH treatment. Some analysts said that NASH will be the next journey of GLP-1 drugs after type 2 diabetes and weight loss indications.

·"If the results of clinical trials show good therapeutic effects, endocrinologists or hepatologists will definitely use it. However, currently, the use of smeglutide in the treatment of NASH is still beyond indications and requires strict review by pharmaceutical management departments before use."

On July 25th local time, according to industry media Endpoints, the star weight loss drug Semaglutide of Danish multinational pharmaceutical company NVO.US was named by clinical doctors as the "most recognized and anticipated" drug in the treatment of non-alcoholic fatty liver disease (NAFLD) and non-alcoholic fatty liver disease (NASH).

A doctor survey conducted by American healthcare data consulting firm Spherix Global Insights showed that 52% -75% of doctors stated that if smeglutide is approved for use in NAFLD and NASH in the future, they are "very likely" to prescribe smeglutide for patients. In addition, 10% -20% of clinical doctors stated that it is "generally possible" to prescribe smeglutide.

Smeglutide is a GLP-1 receptor agonist. GLP-1, namely glucagon like peptide-1, can enhance insulin secretion, reduce food intake, inhibit gastric emptying and digestive tract secretion, and inhibit glucagon secretion, which has a good effect on diabetes and obesity patients.

Why is GLP-1 drug effective for NASH? According to Li Jun, Director of the Hepatobiliary and Pancreatic Surgery Department of the Tenth People's Hospital of Shanghai, GLP-1 binding to liver cell receptors can reduce liver cell steatosis, reduce liver cell damage, and also reduce liver cell glucose output, leading to a decrease in the inflammatory response and fibrosis degree of liver cells during the progression of NASH disease.

From the perspective of clinical treatment, Li Jun believes that if the results of clinical trials show good efficacy, doctors from endocrinology or liver disease departments will definitely use it. However, currently, the use of Smegglutide in the treatment of NASH is still beyond indications and requires strict review by the pharmaceutical management department before it can be used.

According to Li Jun, we are also very cautious about the use of smeglutide in obesity patients clinically

Non alcoholic steatohepatitis is the next step in fatty liver disease

Li Jun introduced that non-alcoholic steatohepatitis (NASH) is a type of fatty liver disease. Fatty liver refers to the liver's fat content exceeding the normal range, and in Western countries, fatty liver is mostly related to alcohol abuse

Non alcoholic steatohepatitis is the next step in fatty liver disease

Li Jun introduced that non-alcoholic steatohepatitis (NASH) is a type of fatty liver disease. Fatty liver refers to the liver's fat content exceeding the normal range. In Western countries, fatty liver is mostly related to alcohol abuse, while in China, fatty liver is mostly related to obesity. The incidence rate of fatty liver in China has reached 30%. This type of obesity related fatty liver disease, also known as non-alcoholic fatty liver disease (NAFLD), is more severe and accounts for 15% -25% of cases. Further progression of NASH can lead to cirrhosis, liver failure, and death.

The exact cause of NASH is still unclear, and it is reported that it is related to obesity, insulin resistance, type 2 diabetes and dyslipidemia. The most common symptoms of severe NASH include general fatigue, nausea, decreased appetite, aversion to oil, bloating, and abdominal pain. If it progresses to liver cirrhosis, there may be yellowing of the skin, spider like vascular enlargement under the skin, gum bleeding, swelling (edema) of the legs and feet, enlargement of the liver or spleen, etc.

Li Jun stated that in terms of symptoms, NASH and other liver inflammations are relatively similar, and there are more accurate diagnostic indicators in clinical practice, such as susceptibility factors; Excluding history of alcohol consumption and viral hepatitis; Elevated serum transaminases, especially elevated alanine aminotransferase (ALT); Imaging may show hepatic steatosis; If patients undergo liver biopsy, they may see balloon like changes in liver cells.

At present, there is no specific treatment method for NASH in medicine. Li Jun told Pengpai Technology that the most important treatment for NASH is weight loss, which can be achieved by changing lifestyle, adjusting dietary structure (controlling calorie intake), and strengthening exercise, thereby reversing the accumulation of fat in liver cells, improving liver damage and fibrosis, and also reducing metabolic diseases such as hypertension, hyperlipidemia, and hyperglycemia.

"Generally speaking, the initial treatment goal for NASH patients is to reduce weight by 10%. However, unfortunately, less than half of people can achieve this goal," said Li Jun. "This is related to individual consciousness and willpower."

Li Jun stated that other treatment options include weight loss surgery, and NASH patients who develop liver cancer or liver failure may require liver transplantation. In addition, there are also medication treatments, which are mainly divided into three categories: the first category is drugs that reduce liver damage, the second category is drugs that improve glucose and lipid metabolism, and some antiplatelet drugs may even use thyroid hormones. Some new drugs are also in use or clinical trials, but their effects need further clarification.