Agents for the treatment of fatty liver disease: focus on essential phospholipids

Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in developed countries, with a prevalence that is increasing. In addition to being a disease of the liver, NAFLD is associated with an increased risk of type 2 diabetes mellitus, chronic kidney disease, and cardiovascular disease, with the latter being the most common cause of death in patients with NAFLD. A large number of agents have been trialed in patients with NAFLD or nonalcoholic steatohepatitis (NASH), with or without comorbidities. However, no pharmacologic agents are yet specifically licensed for the treatment of NAFLD. Current treatment guidelines focus on lifestyle modification (diet and exercise, aiming for weight loss) and pharmacologic treatment of comorbidities. Some guidelines suggest the use of pioglitazone (off-label for nondiabetic patients) or vitamin E in select patients with NASH; however, they also note that there are safety concerns with these agents. Essential phospholipids (EPLs) have been safely used for many years as hepatoprotection in patients with liver disease and are recommended as supportive treatment by some NAFLD treatment guidelines. In this narrative review, we discuss the evidence surrounding the use of various agents as treatments in patients with NAFLD or NASH, with a focus on EPL.