From the Guidelines
GLP-1 receptor agonists like dulaglutide can be prescribed to patients with metabolic associated steatohepatitis (MASH) and fatty liver disease, as they are safe to use in this population and improve cardiometabolic outcomes 1. These medications are increasingly recognized as beneficial treatment options for patients with liver fat accumulation, particularly those with concurrent obesity or type 2 diabetes. The most recent and highest quality study, published in the Journal of Hepatology in 2024, recommends the use of GLP-1 receptor agonists, such as semaglutide, liraglutide, and dulaglutide, for the treatment of non-cirrhotic MASH without cirrhosis (F0-F3) 1. Key benefits of GLP-1 receptor agonists include:
- Improving insulin sensitivity
- Promoting weight loss
- Reducing inflammation All of these factors contribute to liver fat reduction. Patients should be monitored with liver function tests before and during treatment, and the medication is administered as a subcutaneous injection. Some potential side effects of GLP-1 receptor agonists include nausea, vomiting, or diarrhea, which often improve over time. While not specifically FDA-approved for MASH, growing clinical evidence supports their use in this population due to their ability to address the underlying metabolic dysfunction driving liver disease progression 1. It is essential to note that patients with severe liver impairment should be monitored more closely, and the medication should be used cautiously in those with a history of pancreatitis. In summary, GLP-1 receptor agonists are a viable treatment option for patients with MASH and fatty liver disease, and their use is supported by recent clinical guidelines and evidence.
From the Research
GLP-1 Receptor Agonists in MAHS and Fatty Liver Disease
- GLP-1 receptor agonists, such as dulaglutide, have been shown to be effective in treating metabolic dysfunction-associated steatohepatitis (MASH) and fatty liver disease 2.
- These medications have been found to reverse steatohepatitis, reduce cardiovascular risk, and are safe to use across the spectrum of MASH with or without fibrosis 2.
- Dulaglutide, in particular, has been shown to reduce liver fat content and improve liver enzymes in patients with type 2 diabetes and non-alcoholic fatty liver disease (NAFLD) 3, 4.
Contraindications and Safety
- There are no significant contraindications to the use of GLP-1 receptor agonists in patients with MAHS and fatty liver disease, but caution should be exercised in patients with a history of pancreatitis or thyroid cancer 5.
- The safety profile of dulaglutide has been established in several studies, with no serious drug-related adverse events reported 3, 4.
Efficacy in Reducing Liver Fat and Improving Liver Outcomes
- Dulaglutide has been shown to reduce liver fat content by -3.5% and improve liver enzymes, including γ-glutamyl transpeptidase (GGT) levels, in patients with type 2 diabetes and NAFLD 3.
- GLP-1 receptor agonists may also reduce the risk of major adverse liver outcomes (MALO) in patients with chronic liver disease and type 2 diabetes, although this needs to be corroborated in randomized trials 6.
Clinical Use
- GLP-1 receptor agonists, including dulaglutide, can be prescribed to patients with MAHS and fatty liver disease, particularly those with type 2 diabetes, as an adjunct to standard treatment 2, 5.
- The use of dulaglutide in patients with NAFLD and type 2 diabetes may be considered for the early treatment of NAFLD, given its efficacy in reducing liver fat and improving liver enzymes 3, 4.