OCA is the first FXR agonist to complete phase III clinical trials in NASH patients, although the primary goal of NASH resolution was not achieved170, 174.Consequently, the FDA has still not approved OCA for NASH, owing to consistently increased pruritus173 and levels of serum LDL and decreased levels of serum HDL175 (Table 2). This evidence concerns the gene NR1H4 and metabolic dysfunction-associated steatohepatitis.