Non-alcoholic fatty liver disease affects nearly one in three adults in the US, making it the most common chronic liver condition. Most people have simple fat accumulation that stays stable, but about 20% develop NASH — non-alcoholic steatohepatitis — where inflammation and scarring can progress to cirrhosis. Until recently, weight loss through diet and exercise was the only proven treatment.
What's actually going on in research
Trials are testing drugs that target metabolic pathways driving fat buildup and inflammation, including GLP-1 receptor agonists already approved for diabetes, FGF21 analogs that improve how the liver handles fat, and THR-beta agonists that boost fat burning. Researchers are also studying combination approaches and drugs that directly address liver scarring.
GLP-1 drugs for NASH
Semaglutide and tirzepatide, already used for diabetes and weight loss, are showing liver benefits in NASH trials. Their ability to reduce weight and improve insulin resistance may address root causes of the disease.
FGF21-based therapies
Drugs that mimic or activate FGF21, a hormone that regulates fat metabolism, are reducing liver fat and improving metabolic markers in trials. Several candidates are in mid-stage testing.
Antifibrotic drugs
New drugs aim to stop or reverse liver scarring directly, which could prevent progression to cirrhosis. These work differently than metabolic drugs and may be combined with them.
What to know before you search
Eligibility typically requires evidence of NASH or significant fibrosis on biopsy or imaging, though some trials enroll people with simple fatty liver to test prevention.
What types of trials are currently open
- NASH treatment trials — Testing drugs that reduce liver inflammation and fat, often measured by biopsy or imaging after 12-18 months of treatment.
- Fibrosis trials — Studies focused on whether drugs can reduce or stop liver scarring, which determines risk of cirrhosis and liver failure.
- Metabolic combination trials — Testing combinations of drugs that work through different pathways — for example, pairing a GLP-1 drug with a thyroid hormone receptor agonist.
- Biomarker studies — Research to find blood tests or imaging methods that can replace liver biopsy for diagnosis and monitoring.
- Natural history studies — Following people with fatty liver disease over time to understand who progresses and what factors predict worsening.
Recently added Non-alcoholic Fatty Liver Disease trials
Taiwan Green Propolis for Blood Lipids and Body Fat in Patients With MASLD
Metabolic dysfunction-associated steatotic liver disease (MASLD) is a common chronic liver condition linked to excess body fat, high blood lipids, and other metabolic problems. Taiwan green propolis is a natural health product collected by bees from plants, which has shown potential benefits for blood lipids and body fat in laboratory and animal studies. However, its effects in people with MASLD have not been well established in clinical trials. This study is a double-blind, randomized, placebo-controlled trial enrolling up to 60 adults with MASLD at Dalin Tzu Chi Hospital in Taiwan. Eligible participants are randomly assigned in a 1:1 ratio to receive either Taiwan green propolis capsules or matching placebo capsules for 12 weeks. Participants take 2 capsules before breakfast and 2 capsules before dinner each day (4 capsules per day total). Neither participants nor the research team know which capsules are being taken until the study ends. The study measures changes in blood lipids (triglycerides, total cholesterol, LDL-C, and HDL-C), body fat percentage, body weight, waist circumference, liver enzymes, blood sugar levels, inflammatory markers, and health-related quality of life. Liver fat and scarring are assessed by abdominal ultrasound before and after the intervention. Gut microbiota samples are also collected. Assessments are conducted at baseline, at 4 weeks, 8 weeks, 12 weeks (end of intervention), and at follow-up visits 2 weeks and 12 weeks after the intervention ends. The goal of this study is to provide scientific evidence on whether Taiwan green propolis can safely and effectively improve blood lipids, body fat, and metabolic health in people with MASLD, and to explore the relationship between physiological improvements and health behavior changes.
Clinical Course and Biomarkers Associated With Nonalcoholic Fatty Liver Disease (NAFLD) in Chinese Patients With Obesity
Nonalcoholic fatty liver disease (NAFLD) is the most common form of chronic liver disease in many parts of the world. NAFLD can progress to nonalcoholic steatohepatitis (NASH) and result in cirrhosis and liver cancer. Despite NAFLD is common, there are a lot of knowledge gaps about this common disease including the progression from NAFLD to NASH and from fibrosis to cirrhosis, efficacious treatment strategies, etc. In this study, we aim to investigate the clinical course and biomarkers associated with NAFLD in a group of obese patients with or without known history of NAFLD at baseline undergoing laparoscopic bariatric surgery. During laparoscopic surgery, subjects consented to participate will have liver biopsies performed under direct vision and sent for histological analysis and scoring. The patients will undergo comprehensive clinical and biochemical assessment before and after the surgical procedures. The prevalence of NAFLD and clinical course of this group of patients with obesity will be assessed using histology as the gold standard. Clinical characteristics and biomarkers associated with NAFLD will be identified.
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