From the Guidelines
SGLT2 inhibitors can be used in adults with Child–Pugh class A and B cirrhosis, according to the latest clinical practice guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD) 1. The use of SGLT2 inhibitors in MASLD patients has been supported by recent studies, which demonstrate their safety and efficacy in improving liver enzymes and reducing liver fat content 1. Some key points to consider when using SGLT2 inhibitors in MASLD patients include:
- They are safe to use in MASLD and should be used for their respective indications, namely type 2 diabetes, heart failure, and chronic kidney disease 1
- There is insufficient evidence to recommend the use of SGLT2 inhibitors as MASH-targeted therapies; however, they may be considered for individuals with MASLD who have coexisting diabetes, obesity, or cardiovascular disease 1
- The recommended dose of SGLT2 inhibitors, such as empagliflozin or dapagliflozin, is typically 10-25mg daily or 5-10mg daily, respectively, for 24-52 weeks [@Example@]
- SGLT2 inhibitors work by increasing urinary glucose excretion, which leads to weight loss, improved insulin sensitivity, reduced inflammation, and decreased hepatic de novo lipogenesis [@Example@]
- Side effects are generally mild and include genital mycotic infections and volume depletion [@Example@]
From the Research
Data on Using SGLT2 Inhibitors in MAFLD
- The use of sodium glucose cotransporter 2 inhibitors (SGLT2is) in patients with metabolic dysfunction-associated fatty liver disease (MAFLD) has shown promising results 2, 3.
- A retrospective study of 568 patients with MAFLD and type 2 diabetes mellitus (T2DM) found that treatment with SGLT2is significantly decreased the Fibrosis-4 (FIB-4) index, aspartate aminotransferase to platelet ratio index, serum aspartate and alanine aminotransferase (ALT), hemoglobin A1c, and fasting blood sugar 2.
- The study also found that the body weight of patients taking SGLT2is decreased, while those taking pioglitazone experienced an increase in body weight 2.
- Another study discussed the potential roles of SGLT-2 inhibitors and glucagon-like peptide 1 receptor agonists in the prevention and treatment of intrahepatic triacylglycerol accumulation and associated inflammation and/or fibrosis in MAFLD patients 3.
Efficacy and Safety of SGLT2 Inhibitors
- SGLT2 inhibitors, such as canagliflozin, dapagliflozin, and empagliflozin, have been shown to be effective in improving glycemic control, promoting weight loss, and lowering blood pressure in patients with type 2 diabetes mellitus 4, 5.
- However, these medications have also been associated with adverse effects, including urinary and genital tract infections, volume depletion, and lower limb amputation 4, 6.
- A comprehensive review of canagliflozin found that it has anti-inflammatory and anti-cancer properties, and its pharmacokinetics indicate rapid absorption and minimal hepatic metabolism 6.
Comparison with Other Treatments
- A study comparing SGLT2is with pioglitazone found that SGLT2is caused a larger improvement in FIB-4 index than pioglitazone in patients with MAFLD over 96 weeks 2.
- Another study found that SGLT2 inhibitors may be competitive with other anti-diabetic medications, such as sitagliptin, but are not cost-effective compared to gliclazide or pioglitazone in monotherapy 4.