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Invited Commentary
February 27, 2017

The Role of Pioglitazone in the Management of Nonalcoholic SteatohepatitisAre We There Yet?

Author Affiliations
  • 1Los Angeles County Department of Health Services, Los Angeles, California
  • 2Department of Medicine, University of California, San Francisco, San Francisco
JAMA Intern Med. Published online February 27, 2017. doi:10.1001/jamainternmed.2016.9669

Nonalcoholic steatohepatitis (NASH) and its clinical sequelae have become an increasingly prevalent and important cause of hepatic morbidity and mortality.1 Despite almost 2 decades of intense study, we are still not certain how best to treat NASH. In this issue of JAMA Internal Medicine, Musso and colleagues present a meta-analysis that suggests that thizaolidinedione use is associatyed with improvement in advanced fibrosis in NASH, even in patients without diabetes.2 Other medications in the thiazolidinedione class did not demonstrate a significant effect in treatment of nonalcoholic steatohepatitis, therefore this commentary focuses on pioglitazone. Although this article makes a significant contribution to our understanding of the potential role that this thiazolidinedione may have in the management of NASH, there remain substantive questions that need to be addressed before pioglitazone hydrochloride can be recommended as a treatment for patients with NASH.

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