Its utility as a backbone therapy, with a broad range of risk reduction and treatment benefits may erode the market potential of newer, indication-specific therapies, even in areas where semaglutide is not yet explicitly approved, but initial trial readouts show promising results, e.g
Alcohol Consumption: The liver uses significant amounts of glutathione to process alcohol, which can lead to temporary depletion
Bariatric surgery offers lasting weight loss and metabolic health improvements without ongoing medication
abstinence may be advised for those with advanced liver disease Metabolic risk factor management is essential: Optimising glycaemic control in patients with type 2 diabetes (with individualised HbA1c targets, typically 4858 mmol/mol depending on therapy and hypoglycaemia risk) Managing dyslipidaemia with statins where indicated (statins are safe in NAFLD) Controlling hypertension to target blood pressure levels Addressing obesity through structured weight management programmes Regarding pharmacological treatment , NICE currently states that: No medications are specifically licensed for treating NAFLD in the UK Pioglitazone may be considered in patients with type 2 diabetes and biopsy-proven NASH, though this is off-label use Vitamin E may be considered in adults without diabetes who have biopsy-proven NASH, after discussing risks and benefits (off-label use) For GLP-1 receptor agonists like Ozempic, NICE recognises their role in diabetes management and acknowledges emerging evidence for hepatic benefits, but does not currently recommend them specifically for NAFLD treatment outside their licensed indication
A biomarker effect without a clinical one, as seen in EVOKE, is exactly the dissociation that should make researchers cautious about surrogate measures
