Clinical Management of Nonalcoholic Steatohepatitis (NASH) With the Use of Thiazolidinediones and the Additive Effect of Thiazolidinediones and a GLP-1 Agonist: Case Series

We present five cases where patients were diagnosed with nonalcoholic steatohepatitis (NASH) and were treated pharmacologically. This is a common disease that is gaining clinical importance due to the long-term sequelae it may bring to a patient, such as cirrhosis, end-stage liver disease, and hepatocellular carcinoma. Diagnosis and treatment are crucial to make a difference in these patients. Diagnosis is mainly through obtaining alanine transaminase (ALT) and aspartate aminotransferase (AST) levels and excluding excessive alcohol use and other identified liver diseases. Diet and lifestyle are the first options in the treatment of NASH, but some pharmacotherapy has been tested for the cure of NASH. Insulin-sensitizing medications, such as Pioglitazone, have shown beneficial effects but with limited success and increase weight as a side effect. The GLP-1 receptor agonist, which are used in diabetes mellitus type two, has shown significant results in patients with NASH such as decreasing ALT levels, body weight, and hepatic fat.