Findings of a recently published systematic review show that some medications used to treat diabetes may be beneficial for patients with nonalcoholic fatty liver disease (NAFLD) or nonalcoholic steatohepatitis (NASH).

According to current clinical practice guidelines, first-line treatment of NAFLD consists of a combination of lifestyle modifications and management of comorbidities of the disease (ie, obesity, type 2 diabetes, hyperlipidemia, hypertension, metabolic syndrome). To better understand the risks and benefits of diabetes medications in the treatment of NAFLD, the study authors conducted a systematic review that included both published and unpublished studies assessing whether these agents promote weight reduction and steatohepatitis improvement. 

An electronic database search using MEDLINE, EMBASE, the Cochrane Database of Systematic Reviews, as well as the Cochrane Central Register of Controlled Trials yielded 1591 citations, which were then further screened. A total of 18 trials in 17 publications were included in the review. 

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Findings of the analysis revealed that only some diabetes medications are efficacious in patients with NAFLD and NASH. Studies included in the review assessing metformin showed no significant difference in steatosis, fibrosis, NAFLD activity score, or resolution of NASH when compared with placebo. Additionally, although metformin was found to improve weight and glucose control, no evidence supported it having a substantial impact on liver disease. 

Conversely, studies that evaluated pioglitazone in patients with NASH revealed positive effects on liver fat and function, as well as NASH resolution. However, significant weight gain was noted as a possibility for patients taking pioglitazone, which may be cause for concern. “Evidence for other thiazolidinediones was more limited and had somewhat mixed results, but findings were generally consistent with those for pioglitazone: liver fat and function and glucose measures improved, but weight also increased,” the authors explained.

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Findings of the analysis also revealed that some evidence indicates that liraglutide improves liver fat, liver function, and HbA1c, and may aid in NASH resolution and weight reduction. The study authors also reported that although exenatide did not perform as well as liraglutide, it did produce significant reductions in liver fat as well as weight loss. 

“Consistent with existing clinical practice guidelines, which recommend lifestyle intervention and treatment for comorbidities related to fatty liver disease as first-line treatment, trial evidence supports the efficacy of some diabetes drugs (especially pioglitazone) in patients with NAFLD or NASH, though weight gain with some diabetes drugs may warrant caution,” the authors concluded. They recommended that additional trials with larger study populations should be conducted in the future to better assess the risks and benefits of these medications for NAFLD and NASH patients.

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This article originally appeared on MPR