A common drug shows promise for patients with liver disease
A recent Chinese clinical trial published in The BMJ reveals that dapagliflozin, a type 2 diabetes drug, shows promise in treating severe liver conditions like MASH and liver fibrosis. The study, involving 154 participants, demonstrated significant improvements in MASH and fibrosis among those receiving dapagliflozin compared to the placebo group, suggesting a potential new treatment avenue.
Liver disease accounts for two million deaths annually. This is 4% of all deaths (1 out of every 25 deaths worldwide), as per the
data
from 2023. Liver disease is a growing global health concern.
A new study suggests that a widely used diabetes medication may offer hope for patients suffering from progressive liver disease.
A recent clinical trial conducted in China and published in
The BMJ
suggests that the type 2 diabetes drug dapagliflozin can help patients with severe liver conditions such as metabolic dysfunction-associated steatohepatitis (MASH) and liver fibrosis, which have limited treatment options.
What does the diabetes drug do
(Pic courtesy: iStock)
Dapagliflozin, a sodium-glucose cotransporter 2 (SGLT-2) inhibitor, which is widely used to treat type 2 diabetes, has been shown to improve progressive liver disease.
The Chinese researchers found that the drug improved metabolic dysfunction-associated steatohepatitis (MASH), a condition where excess fat accumulates in the liver, leading to inflammation and liver fibrosis (a buildup of scar tissue).
MASH affects more than 5% of adults, and it is also common (30%) in people with diabetes or obesity.
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This can progress to cirrhosis in up to 25% of individuals. Though previous studies have suggested that SGLT-2 inhibitors can improve liver fat content, liver enzymes, and liver stiffness, no trial has been carried out in patients with MASH.
The study
To understand the effects of dapagliflozin in patients with MASH, the researchers conducted a study. The 48-week study had 154 participants, who were diagnosed with MASH following liver biopsies at six Chinese medical centers from November 2018 to March 2023.
Participants had an average age of 35, and 85% were men. Nearly half (45%0 had type 2 diabetes, and most had evidence of liver fibrosis at various stages (33% stage 1, 45% stage 2, 19% stage 3).
Following an initial screening biopsy, the participants were randomly assigned to receive 10 mg of dapagliflozin or a matching placebo once daily for 48 weeks. They attended health education sessions twice a year. The researchers also recorded body weight, blood pressure, blood glucose, liver enzymes, physical activity, diet, insulin, and lipids of the participants throughout the trial.
MASH improvement was defined as a decrease of at least 2 points in non-alcoholic fatty liver disease activity score (NAS) or a NAS of 3 points or less. By the end of the study, which is after 48 weeks, the researchers observed that 53% (41 of 78) participants in the dapagliflozin group showed improvement in MASH without worsening of fibrosis (defined as no increase in fibrosis stage) compared with 30% (23 of 76) in the placebo group.
23% (18 of 78) participants in the dapagliflozin group showed resolution of MASH without worsening of fibrosis, compared with 8% (6 of 76) in the placebo group.
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They also saw improvement in fibrosis without worsening of MASH in 45% (35 of 78) participants in the dapagliflozin group compared with 20% (15 of 76) in the placebo group.
1% (1 of 78) in the dapagliflozin group and 3% (2 of 76) in the placebo group discontinued the treatment because of adverse events.
What are the experts saying
Fatty liver
'Our findings indicate that dapagliflozin may affect key aspects of MASH by improving both steatohepatitis and fibrosis,' they said. They added that large-scale and long-term trials are needed to further confirm these effects. The trial was conducted in a Chinese population, which limits its broader generalisability.
They also noted that with the emergence of more drugs, therapeutic decisions will likely become increasingly tailored to individual patient profiles, they write. 'Ideally, such treatments should provide cardiovascular benefit, have an established safety profile, and be accessible to broad and diverse patient populations,' they concluded.
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A new international study has found that over 15 million people across the US, UK, Germany, and France are unknowingly living with metabolic dysfunction-associated steatohepatitis (MASH), the most aggressive form of fatty liver disease. Despite its serious risks—including liver failure, cancer, and other chronic illnesses—more than three-quarters of affected individuals remain undiagnosed. Researchers are urging wider screening, especially among those with obesity and type 2 diabetes, and highlighting the potential role of weight-loss medications in treatment. Tired of too many ads? Remove Ads Widespread but Largely Undetected Progressive and Potentially Fatal Tired of too many ads? Remove Ads Urgent Need for Diagnosis and Treatment Potential Role of Weight Loss Medications Risk Factors and Screening A recent international study has revealed that millions of people in the US and Europe may be unknowingly living with a dangerous form of fatty liver disease. Published in The Lancet Regional Health Europe, the research indicates that a vast number of individuals are affected by metabolic dysfunction-associated steatotic liver disease (MASLD), with the majority still study examined populations in the United States, United Kingdom, Germany, and France, and found that approximately 20 million people across these countries have the more severe variant of MASLD known as metabolic dysfunction-associated steatohepatitis (MASH). Alarmingly, only about 2.5 million have received a formal diagnosis. This means roughly three-quarters of those with the disease—an estimated 16.7 million individuals—remain unaware of their is the updated term for non-alcoholic fatty liver disease (NAFLD), and it affects people whose liver contains over 5% fat despite little or no alcohol intake. While many patients only develop the earliest and less severe stage known as simple fatty liver, the disease can progress without symptoms and cause serious damage over the aggressive form of the disease, is associated with inflammation and can lead to fibrosis, or scarring of the liver. If not managed, it may progress to cirrhosis, a stage marked by irreversible liver damage and potential liver failure. The condition is also linked to higher risks of cardiovascular issues, chronic kidney disease, and liver study's findings emphasize the urgency of early diagnosis, especially as MASH is particularly common among people with type 2 diabetes and those who are overweight or obese. Researchers noted that around two-thirds of individuals with type 2 diabetes are thought to have Jeffrey Lazarus, the lead author of the study, stressed the economic and health burden posed by undiagnosed MASH. He pointed out that without a significant increase in diagnosis and treatment, the financial costs to healthcare systems could triple over the next two Emmanouil Tsochatzis of University College London echoed this warning, stating that over 15 million people in the US and Europe are living with the most severe form of fatty liver disease without knowing it. He warned that both human suffering and economic consequences could worsen significantly if diagnosis rates do not MASH has been diagnosed through liver biopsy, but newer, non-invasive tools such as blood tests, ultrasound, and MRI scans have made screening easier. Experts now recommend that individuals with type 2 diabetes, obesity combined with other risk factors, or persistently elevated liver enzymes undergo regular study has also brought renewed attention to the potential of weight loss medications to help manage MASH. Dr. Paul Brennan, a hepatologist and co-author of the study, highlighted the promise of GLP-1 agonists like Wegovy and Mounjaro. These drugs work by reducing appetite and slowing digestion, leading to weight loss, which in turn may help reduce fat accumulation and scar tissue in the Betel, president of the Fatty Liver Alliance, stressed that individuals with type 2 diabetes or obesity are often not screened for MASH until significant liver damage has occurred. He called for broader liver health assessments and, when appropriate, the use of weight loss drugs as part of a comprehensive treatment strategy.A separate study released around the same time found that the diabetes drug dapagliflozin not only helps reduce blood sugar but also lowers fat and scarring in the liver, suggesting another potential treatment to health authorities like the NHS, those at greater risk of MASLD include people who are overweight, have type 2 diabetes, high blood pressure, high cholesterol, metabolic syndrome, or are over the age of 50. Smoking and thyroid disorders may also increase the typically begin diagnosis with blood tests that show elevated liver enzymes. If abnormalities are detected, further assessments such as imaging scans or liver elastography (FibroScan) are used to evaluate liver fat and fibrosis the growing prevalence of MASLD and MASH, the study underscores the critical importance of early screening, timely intervention, and broader public health awareness to address this hidden but escalating health threat.
