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This is an **oral combination therapy** under investigation for the treatment of **advanced fibrosis due to nonalcoholic steatohepatitis (NASH)**. The three components are: - **Selonsertib**: an apoptosis signal-regulating kinase 1 (ASK1) inhibitor, aiming to reduce inflammation and fibrosis in the liver. - **Firsocostat**: an acetyl-coenzyme A carboxylase (ACC) inhibitor that targets de novo lipogenesis and reduces hepatic fat accumulation. - **Cilofexor**: a farnesoid X receptor (FXR) agonist that modulates bile acid metabolism and exerts anti-inflammatory and anti-fibrotic effects. These agents have been evaluated alone and in two-drug combinations, but not all three together, in phase 2 trials for their effects on liver histology, NASH activity, and liver fibrosis in patients with bridging fibrosis or compensated cirrhosis due to NASH. The combination has not demonstrated statistically significant benefit on the primary endpoint (fibrosis improvement without NASH worsening) but has produced improvements in secondary endpoints including reductions in liver fat, hepatic inflammation, and markers of liver injury.
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