Obeticholic acid as a steroidal FXR agonist reduces fibrosis and essential NASH features in a phase III trial (NCT02548351).379 However, it causes side effects, such as mild to moderate itching, a decrease of high-density lipoprotein-cholesterol (HDL-C), an increase of low-density lipoprotein-cholesterol (LDL-C), and drug-induced hepatotoxicity.380 EDP-305, another powerful steroidal FXR agonist, lowers the levels of hepatic ALT and fat in phase IIa clinical trial (NCT03421431). This evidence concerns the gene NR1H4 and metabolic dysfunction-associated steatohepatitis.