非酒精性脂肪性肝病(NAFLD)是一种非常普遍的疾病和未满足的临床需求,我们最近提出将其更名为脂肪肝(FLD),以简化和准确。具有特定的子分类。它通常与代谢合并症有关,包括肥胖,2型糖尿病(T2D),高血压,和高脂血症。由于迄今为止没有联邦和药物管理局(FDA)批准的治疗方法,最近的指南推荐生活方式干预,减肥手术,和药物治疗,即胰高血糖素样肽-1受体激动剂(GLP-1RA),过氧化物酶体增殖物激活受体-γ(PPAR-γ)激动剂,和SGLT-2抑制剂用于其治疗。一种治疗T2D的新药物,泰西帕肽,一个双GIP/GLP-1RA,在指南发布一周后才获得FDA的批准,和正在进行的临床试验表明,不仅对T2D,而且对体重和脂肪变性都有希望的结果。此外,我们意识到在FLD的保护下存在不同的子组,因此,需要更精确的治疗建议,以实现针对这些亚组的个性化医疗和治疗的目标.由于代谢领域进展非常快,并且在可预见的未来,几种分子在发展中很可能在NAFLD治疗中显示出益处,指南需要经常更新。这种快速的变化促使我们提出,准则应作为生活在线文件存在于专业协会的网站上,以便它们继续被更新,并反映出这一医学领域和其他医学领域的快速进展。
Non-Alcoholic Fatty Liver Disease (NAFLD) is a highly prevalent disease and unmet clinical need that we have recently proposed to be renamed for simplicity and accuracy as Fatty Liver Disease (FLD), with specific subclassifications. It has been commonly associated with metabolic comorbidities, including obesity, type 2 diabetes (T2D), hypertension, and hyperlipidemia. Since no Federal and Drug Administration (FDA) approved treatments exist to date, recent
guidelines recommend lifestyle interventions, bariatric surgery, and pharmacotherapy, i.e. glucagon-like peptide-1 receptor agonists (GLP-1RA), peroxisome proliferator-activated receptor-γ (PPAR-γ) agonists, and SGLT-2 inhibitors for its treatment. A new and novel medication for the treatment of T2D, tirzepatide, a dual
GIP/GLP-1RA, was approved by the FDA only one week after
guidelines were published, and ongoing clinical trials demonstrate promising results not only for T2D but also for body weight and steatosis. Moreover, we realize that distinct subgroups exist under the umbrella of FLD and, thus, more precise therapeutic recommendations would be needed towards the goal of personalized medicine and therapeutics for these subgroups. As the metabolism field is moving forward very fast and as several molecules in development will most likely demonstrate benefits in NAFLD treatment in the foreseeable future,
guidelines will need to be frequently updated. This rapid pace of change prompts us to propose that
guidelines should exist as living online documents on the websites of professional societies, so that they continue being updated following and reflecting the rapid progress in this and other fields of medicine.