The primary end point being assessed is mean change in hepatic venous pressure gradient as well as event-free survival. Galectin-3 Galectin-3 is expressed primarily in immune cells and is crucial for the development of liver fibrosis. type 2 and type 5 antagonists have been shown to inhibit the progression of fibrosis toward cirrhosis. Summary There are currently several agents in the drug pipeline for NASH. Within the next few years, the availability of therapeutic options for NAFLD will hopefully curb the rising trend of NAFLD-related end stage liver disease. = 0.045). The CEP-18770 (Delanzomib) inability to demonstrate benefit was thought to be due to the high placebo response rates in study participants with mild to moderate NASH [NAFLD activity score (NAS) 3C5]. Exclusion of study participants with mild disease at baseline showed that the 120 mg/day dose was statistically superior to placebo for both definitions of NASH HESX1 resolution. Based on these results, a phase 3 trial is currently recruiting NASH study participants with NAS >4 who will be randomized to elafibranor 120 mg/day versus placebo for 72 weeks. Histological primary end point of NASH resolution without worsening of fibrosis, together with a clinical coprimary composite end point based on mortality, cirrhosis, and liver-related outcomes will be assessed (“type”:”clinical-trial”,”attrs”:”text”:”NCT02704403″,”term_id”:”NCT02704403″NCT02704403). PPAR is primarily expressed in adipose tissue and regulates glucose metabolism, lipogenesis, and adipose tissue differentiation. Thiazolidinediones, including pioglitazone, are CEP-18770 (Delanzomib) PPAR agonists used in the treatment of diabetes and demonstrated to be effective in NASH CEP-18770 (Delanzomib) . The glitazars CEP-18770 (Delanzomib) are dual PPAR/ agonists which aim to combine the beneficial effects of activating both PPAR receptors. Saroglitazar, currently the only glitazar in clinical use because of safety concerns with other members of the category, has been shown to improve diabetic dyslipidemia [18,19] and is currently approved in India for this indication. In a mouse model of NASH, saroglitazar was found to reduce steatosis and ALT, and improve liver histology . A subsequent retrospective study of NAFLD patients with dyslipidemia treated with saroglitazar for 24 weeks showed a significant decrease in ALT compared with baseline . A phase 2 open-label study (PRESS VIII) evaluated the effectiveness of saroglitazar among 32 patients with biopsy-proven NASH . After 12 weeks of treatment, a 52% decrease in ALT was shown. A phase 3 RDBPCT is currently ongoing in India to assess the effect of saroglitazar versus placebo for 52 weeks in biopsy-proven noncirrhotic NASH (Clinical Trials Registry-India CTRI/2015/10/006236). Farnesoid X receptor Bile acids can negatively regulate bile acid synthesis, decrease hepatic gluconeogenesis, and lipogenesis through interaction with their intracellular receptor, the farnesoid X receptor (FXR). A synthetic bile acid agonist CEP-18770 (Delanzomib) of FXR, obeticholic acid (OCA; 6-ethyl-chenodeoxycholic acid) was evaluated in a phase 2b clinical trial (FLINT) in which 283 study participants with biopsy-proven noncirrhotic NASH (NAS >4) were randomized to OCA 25 mg/day versus placebo for 72 weeks . The principal end stage of histological improvement, proven as decrease in NAS by several points, without worsening of fibrosis was reached in 45% of research individuals on OCA versus 21% of these on placebo (= 0.0002). Quality of NASH was proven in 22% of OCA research individuals versus 13% of placebo (= 0.08); and fibrosis rating reduced in 35% of OCA research individuals versus 19% of placebo (= 0.004). Research individuals on OCA demonstrated a significant reduction in BMI in comparison to those on placebo (BMI lower by 0.7 kg/m3 versus gain of 0.1 kg/m3, respectively). OCA treatment, nevertheless, reduced high-density lipoprotein cholesterol, while raising low-density lipoprotein cholesterol, and total cholesterol. These adjustments in cholesterol occurred primarily in the initiation from the scholarly research and improved with continuing treatment; whether these noticeable adjustments result in increased cardiovascular risk continues to be.