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Inflammation and oxidative stress The impact of GLP-1RAs on hepatic lipotoxicity has been extensively explored in cellular and animal models, whereas few clinical studies have been conducted ( Gut-liver axis Lipoproteins production by the liver and by the intestine is subject to a variety of hormonal and nutritional modulators and is deranged in T2D as well as in insulin resistant states including NAFLD ( GLP-1RAs and clinical trials in NAFLD Lixisenatide In a systematic meta-analysis including 12 randomized controlled trials (RCTs) comparing lixisenatide to placebo or active interventions in T2D, lixisenatide was reported to normalize levels of alanine aminotransferase (ALT) in a greater proportion of overweight and obese patients with T2D than comparators ( Exenatide Almost all human studies with exenatide twice-daily evaluating NAFLD-related endpoints involve patients with T2D

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People with complex or inherited disorders may also be referred for pediatric metabolism and nutrition care or adult metabolic assessment, depending on age and symptoms

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Women of childbearing potential taking topiramate must use highly effective contraception and comply with the MHRA Pregnancy Prevention Programme