Hormonal
Pioglitazone (a PPAR-gamma agonist) significantly improves liver inflammation and steatosis in NASH patients, including those with Type 2 Diabetes, but is limited by side effects like weight gain and heart failure risk.
Pioglitazone is an effective, low-cost option for improving liver inflammation in diabetic patients with NASH. However, it is not a first-line choice for everyone due to side effects like weight gain, bone loss, and potential heart failure exacerbation. It is best considered for patients who do not have heart failure or osteoporosis, and who are monitored closely by their doctor.
Treatment with pioglitazone at 30 mg/day has led to statistically important improvement of inflammation in patients with NASH, with or without diabetes... showed that pioglitazone caused significant reductions in steatosis, inflammation, hepatocellular ballooning and improvement in insulin resistance and liver-enzyme levels
Why this rating
Supported by the PIVENS study and other RCTs cited.
Source
Pharmacotherapy for Non-alcoholic Fatty Liver Disease Associated with Diabetes Mellitus Type 2
Emmanouil S. Koullias et al. · Journal of Clinical and Translational Hepatology · 2022
DOI 10.14218/jcth.2021.00564
More from this paper
- GLP-1 receptor agonists (specifically liraglutide and semaglutide) significantly improve histological features of NASH (steatohepatitis resolution) and reduce liver fat content in patients with Type 2 Diabetes, though they may not consistently improve fibrosis.Good
- SGLT2 inhibitors (specifically empagliflozin and dapagliflozin) reduce liver fat content and may improve fibrosis markers in patients with Type 2 Diabetes, offering a cardioprotective and renoprotective alternative to GLP-1 agonists.Good
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- 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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