Anti-TNF therapy is based on the role of TNF-α in necroinflammation and insulin resistance. Pentoxifylline (a TNF-α inhibitor) in several trials improved liver enzymes and cytokine-mediated systemic inflammation [66] and reduced histological steatosis and necroinflammationin in patients with NASH [63] as demonstrated in the work of Zein at al. [67]. Here, TNF is linked to metabolic dysfunction-associated steatohepatitis.