What is Advanced Fibrosis due to

Advanced fibrosis due to NASH puts patients at high risk of progressing to serious outcomes

Nonalcoholic steatohepatitis (NASH) is a severe form of nonalcoholic fatty liver disease (NAFLD) that occurs when excessive amounts of fat build up in the liver, damaging hepatocytes and causing the liver to become inflamed. Together, this can lead to fibrosis, the buildup of scar tissue that hinders the liver’s ability to function properly.

nash with early advance fibrosis stages

nash with early advance fibrosis stages

meet beth with nash


A professional actor in New York who is living with liver fibrosis due to NASH.

Consequences of advanced fibrosis

Over time, damage to the liver may become more severe, resulting in advanced fibrosis where the liver is permanently damaged and scarred and unable to function properly. Having advanced fibrosis puts individuals at an increased risk of serious, life-threatening clinical outcomes, including end-stage liver failure and its complications, hepatocellular carcinoma (liver cancer), the need for liver transplantation and even death.

For patients with advanced fibrosis due to NASH, halting progression to cirrhosis is critical. After approximately 2.5 years, ~1 in 5 patients with advanced fibrosis due to NASH may progress to cirrhosis.*

Diagnosis and management

Historically, the standard test to confirm the diagnosis of advanced fibrosis due to NASH has been a liver biopsy, in which a small sample of the liver is removed and examined. However, in addition to being a costly procedure, liver biopsy is associated with numerous limitations including the potential for inconsistent findings, pain, discomfort and the risk of rare but life-threatening complications. Today, noninvasive tests (NITs) play a much larger role in management of the disease: a large U.S. claims database showed that less than 10% of all NASH patients had a biopsy. Professional societies and regulatory authorities are encouraging NIT research to help the hepatology community advance patient care.

The treatment of advanced fibrosis due to NASH is currently limited to lifestyle changes and specific treatment of comorbidities. People with advanced fibrosis due to NASH are advised to make dietary changes and exercise to lose weight, and to avoid heavy alcohol consumption.

New treatments are urgently needed

While lifestyle changes can be helpful in managing the disease, many patients find that losing weight by adjusting diet and committing to exercise can be difficult to achieve and even more difficult to maintain. Because patients with advanced fibrosis due to NASH are at the greatest risk of progressing to severe liver-related outcomes, an approved medication is needed that halts or improves liver fibrosis.

OCA is in Phase 3 clinical development for advanced fibrosis due to NASH

We are currently evaluating obeticholic acid (OCA) as a potential treatment for advanced fibrosis due to NASH in an ongoing Phase 3 clinical trial, REGENERATE.

REGENERATE (Randomized Global Phase 3 Study to Evaluate the Impact on NASH with Fibrosis of Obeticholic Acid Treatment) is a randomized, double-blind, placebo-controlled, multicenter trial. It is assessing the safety and potential benefit of OCA on liver-related clinical outcomes in NASH patients with fibrosis. Read more about REGENERATE here.

OCA has not been approved for the treatment of NASH by any regulatory authority in any geography and is considered an investigational treatment for this indication.

*In a study of patients with biopsy-proven NASH, 48 of 217 patients (22%) with advanced fibrosis without cirrhosis progressed to advanced fibrosis with cirrhosis at around 29 months.