Non-alcoholic steatohepatitis (NASH) is liver inflammation caused by fat buildup in people who drink little or no alcohol, and it is rapidly becoming a leading cause of cirrhosis, liver failure, and liver cancer. Until recently no approved treatments existed, but that has changed.
What's actually going on in research
Resmetirom, a thyroid hormone receptor-beta agonist, became the first approved treatment for NASH with liver fibrosis, and it reduces both fat and inflammation in the liver. Multiple other drugs — including GLP-1 agonists, FGF21 analogs, and ACC inhibitors — are in late trials and several combinations appear additive. The field is moving rapidly from single-agent to combination therapy trials as researchers recognize that NASH has multiple driving pathways.
Resmetirom (THR-beta agonist)
Resmetirom activates thyroid hormone receptors specifically in the liver to reduce fat accumulation and inflammation. It is now approved for NASH with fibrosis and is becoming the backbone of combination trials.
GLP-1 agonists in NASH
Semaglutide and tirzepatide reduce liver fat, inflammation, and body weight dramatically and are in Phase 3 trials specifically measuring fibrosis resolution as the primary endpoint.
Combination therapy
Trials are testing two or three drugs targeting different NASH pathways simultaneously — such as a GLP-1 agonist plus a FGF21 analog — to achieve more complete liver fibrosis regression.
What to know before you search
Eligibility requires liver biopsy confirmation of NASH with fibrosis stage (typically F2–F3), often includes BMI and liver enzyme thresholds, and excludes other liver diseases.
What types of trials are currently open
- Drug trials — Testing new medications targeting liver fat, inflammation, and fibrosis in NASH.
- Combination therapy trials — Evaluating two- and three-drug combinations targeting different NASH pathways simultaneously.
- Cirrhosis trials — Testing whether NASH drugs can benefit patients who have already progressed to early cirrhosis.
- Metabolic syndrome trials — Combining NASH therapy with weight loss and cardiovascular risk reduction strategies.
- Biomarker trials — Validating non-invasive liver tests (MRI, blood biomarkers) to replace repeated liver biopsies in trials.
Recently added Non-alcoholic Steatohepatitis trials
Effects of Peanut Consumption on Adults With Metabolic Associated Fatty Liver Disease
The aim of this randomized interventional trial is to understand the effects of peanut consumption on patients with metabolic associated fatty liver. The main goal is to investigate if patients who consume peanuts have improved liver marker tests as well as metabolic profile. We will also investigate how peanuts alter the gut microbes and liver fat content in patients with metabolic associated fatty liver. * Participants will be randomized into intervention (peanut consumption for 12 weeks) and control (regular diet) arm. * Stool sample and blood (for biomarkers) collection across both arms at baseline and post-intervention * Daily log to be completed for tracking peanut consumption * 2-day Dietary recall at baseline, during Week 6 and Week 12 * Poat intervention Fibro scans for participants with baseline scans available
Diagnostic Value of the Liver Inflammation Index for MASH in Patients With T2DM and MAFLD
This observational study aims to evaluate a new diagnostic tool, the Liver Inflammation Index, in detecting Metabolic Dysfunction-Associated Steatohepatitis (MASH) among adults who have both Type 2 Diabetes Mellitus (T2DM) and Metabolic Dysfunction-Associated Fatty Liver Disease (MAFLD).
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