**Japan:** A study entitled “Effects of sodium-glucose cotransporter two inhibitors and pioglitazone on FIB-4 index in metabolic associated fatty liver disease” has concluded that among patients with metabolic dysfunction-associated fatty liver disease (MAFLD), treatment with SGLT2i essentially improves FIB-4 index over 96 weeks. Researchers compared these results with pioglitazone and confirmed the efficacy of SGLT2i is better than pioglitazone.

In patients with non-alcoholic fatty liver disease and type 2 diabetes mellitus (T2DM), the beneficial effects of sodium-glucose cotransporter two inhibitors (SGLT2i) and thiazolidinediones on liver dysfunction are already known.

Researchers from the Department of Gastroenterology and Hepatology at National Center for Global Health and Medicine Kohnodai Hospital, did a retrospective study of 568 patients and determined the efficacy of these drugs for managing liver disease in patients with a history of MAFLD and T2DM.

The study points are:

- 95 patients were treated with SGLT2i
- 86 patients were treated with pioglitazone.
- Twenty-nine patients were treated with both.
- The primary outcome measured was the change in fibrosis (FIB)-4 index between baseline and 96 weeks.
- There was a significant decrease at 96 weeks in the mean FIB-4 index in the SGLT2i group. This was not recorded in the pioglitazone group.
- In both the groups, there was a decrease in aspartate aminotransferase to platelet ratio index (APRI), serum aspartate and alanine aminotransferase (ALT), haemoglobin A1c, and fasting blood sugar significantly decreased in both groups.
- The ALT in the SGLT2i group and pioglitazone was -17 ± 3 IU/L and -14 ± 3 IU/L, respectively.
- The body weight decreased in the SGLT2i group and increased in the pioglitazone group increased.
- As per baseline ALT (>30 IU/L), the FIB-4 index significantly decreased in both groups.
- Adding SGLT2i improves liver enzymes but not the FIB-4 index for 96 weeks in patients taking pioglitazone.

Concluding further, treatment with SGLT2i improves the FIB-4 index compared to pioglitazone MAFLD patients over 96 weeks.

Further reading:

Mino, Masaaki, et al. “Effects of Sodium-Glucose Cotransporter 2 Inhibitors and Pioglitazone On FIB-4 Index in Metabolic Associated Fatty Liver Disease.” Hepatology Research: the Official Journal of the Japan Society of Hepatology, 2023. https://www.unboundmedicine.com/medline/citation/36905232/full_citation

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