Treatment with the synthetic FXR agonist obeticholic acid improved the homeostatic model assessment insulin-resistance (HOMA-IR), a measure of insulin resistance, in patients with NAFLD.[12] The phase 2 FLINT trial of OCA in NAFLD was stopped early when it showed a clear benefit of OCA, with improved steatosis, lobular inflammation and fibrosis scores on repeat biopsy in OCA treated patients compared to placebo.[12] Treatment with an engineered FGF19, NGM282, has also shown promise in NASH.[13]. This evidence concerns the gene NR1H4 and metabolic dysfunction-associated steatohepatitis.