Hormonal
Pioglitazone improves NASH histology without worsening fibrosis in patients with T2DM and MAFLD, but its use is limited by side effects including weight gain, fluid retention, and potential bladder cancer risk.
Pioglitazone (45mg daily) can improve liver inflammation (NASH) in people with type 2 diabetes and fatty liver without worsening scarring. However, it can cause weight gain, fluid retention, and may increase the risk of bladder cancer in some people. It is not recommended for everyone and should be used with caution, especially if you have a history of heart failure or bladder cancer.
Significant improvement in NASH without worsening of fibrosis was seen with the use of pioglitazone dose of 45 mg daily (relative risk: 2.64, 95%CI: 1.36; 5.12).
Why this rating
Supported by grade A, high strength evidence for NASH improvement, but long-term safety data is mixed.
Source
Management of metabolic-associated fatty liver disease: The diabetology perspective
Mohammad Sadiq Jeeyavudeen et al. · World Journal of Gastroenterology · 2023
DOI 10.3748/wjg.v29.i1.126
More from this paper
- Lifestyle interventions achieving 7-10% body weight loss are effective in resolving nonalcoholic steatohepatitis (NASH) and regressing fibrosis in patients with metabolic-associated fatty liver disease (MAFLD).Good
- GLP-1 receptor agonists (GLP-1RAs) significantly improve liver enzymes (AST, ALT, GGT) and reduce fibrosis scores in patients with MAFLD and T2DM, though they are not recommended as a primary treatment for NASH histology in the absence of diabetes.Good
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