Hormonal
Weekly subcutaneous semaglutide (up to 2.4 mg) significantly reduces liver steatosis and liver enzymes in patients with NAFLD/NASH, but does not significantly improve liver fibrosis or achieve NASH resolution compared to placebo in patients with compensated cirrhosis.
For patients with advanced liver disease (cirrhosis), weekly semaglutide injections (2.4 mg) can significantly reduce liver fat and inflammation markers, but they should not expect it to reverse scarring (fibrosis) or cure NASH. The treatment is safe and effective for metabolic control and steatosis reduction, even if it doesn't change the fibrosis stage.
At the end of study, although in the placebo group a higher proportion of patients met the primary end point compared to the semaglutide group, this difference was not significant (29% vs. 11%, p = 0.087). There was also no difference between groups in the proportion of patients who achieved NASH resolution (p = 0.29)... However, at week 48, improvement in liver steatosis assessed by MRI-PDFF was greater in the semaglutide group than in the placebo group (p = 0.042)... reductions in ALT, AST and γGT levels from baseline were significantly greater in the semaglutide group vs. the placebo group (p = 0.009, 0.046 and 0.037, respectively).
Why this rating
Based on a randomized, placebo-controlled phase II trial (Loomba et al., 2023) with a clear negative primary endpoint for fibrosis but positive secondary endpoints for steatosis.
Source
Evolving role of semaglutide in NAFLD: in combination, weekly and oral administration
Evgenia Koureta et al. · Frontiers in Pharmacology · 2024
DOI 10.3389/fphar.2024.1343587
More from this paper
- Combining semaglutide with cilofexor or firsocostat improves liver steatosis more than semaglutide monotherapy in patients with NASH and mild-to-moderate fibrosis, without significantly affecting liver stiffness.Moderate
- Oral semaglutide (up to 14 mg daily) significantly reduces liver steatosis, liver enzymes, and body weight in patients with NAFLD and Type 2 Diabetes, correlating with weight loss.Moderate
Related findings · Hormonal
- Initial treatment for type 2 diabetes should be a combination of metformin and either an SGLT-2 inhibitor or a GLP-1 receptor agonist to achieve cardiorenal protection, rather than monotherapy or older agents like sulfonylureas.Strong
- For patients with specific monogenic obesity syndromes (leptin deficiency, POMC/PCSK1/LEPR mutations), targeted pharmacotherapy (recombinant leptin or setmelanotide) is highly effective and should be prioritized, unlike in polygenic obesity.Strong
- Continued weekly administration of 2.4 mg subcutaneous semaglutide prevents weight regain and promotes further weight loss in adults with overweight or obesity, whereas switching to placebo results in significant weight regain.Strong
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