NR1H4 and metabolic dysfunction-associated steatohepatitis: While such effects may be beneficial for cholesterol catabolism, FXR-antagonistic properties could also explain UDCA’s limited clinical efficiency [9], [10], [11] in comparison to FXR agonist obeticholic acid, which is associated with increased insulin sensitivity upon 6 weeks treatment in diabetic NAFLD patients and improved liver histology but not IR upon 72 weeks of administration in NASH patients [29], [30].