NR1H4 and metabolic dysfunction-associated steatohepatitis: Tropifexor was primarily designed as an anti-NASH therapeutic and has completed a phase I safety trial.552,594 Recently a phase IIa/b trial FLIGHT-FXR was completed in which decreases in alanine transaminase levels, decreased hepatic fat fraction, increased weight loss, and improved surrogate markers for NASH improvement but not actual histological disease improvement were observed.594,595 In addition, tropifexor was found to increase serum LDL cholesterol and cause pruritis.