Internal Medicine
Online ISSN : 1349-7235
Print ISSN : 0918-2918
ISSN-L : 0918-2918

This article has now been updated. Please use the final version.

SGLT2 Inhibitor Treatment Outcome in Nonalcoholic Fatty Liver Disease Complicated with Diabetes Mellitus: The Long-term Effects on Clinical Features and Liver Histopathology
Norio AkutaYusuke KawamuraShunichiro FujiyamaHitomi SezakiTetsuya HosakaMasahiro KobayashiMariko KobayashiSatoshi SaitohFumitaka SuzukiYoshiyuki SuzukiYasuji AraseKenji IkedaHiromitsu Kumada
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JOURNAL OPEN ACCESS Advance online publication

Article ID: 4398-19

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Abstract

Objective The aim of this study was to determine the long-term effects of an SGLT2 inhibitor (SGLT2i) in NAFLD patients with type 2 diabetes mellitus (T2DM) on the clinical features and liver histopathology.

Methods In this retrospective study, the long-term histological impacts of SGLT2i in NAFLD patients with T2DM were investigated.

Patients or Materials Seven patients with NAFLD and T2DM were treated for the long term with 100 mg/day canagliflozin, an SGLT2i, and liver biopsies were obtained at the 3 points of pretreatment, 24 weeks, and ≥1 year (third liver biopsy) after the start of treatment. Six of seven patients were evaluated with third liver biopsy at the point of three or more years. The primary outcome was liver histopathological changes (defined as a decrease in the NAFLD activity score of one point or more without worsening of the fibrosis stage, compared to pretreatment).

Results All 7 patients showed worsening of body mass index and waist circumference at the third liver biopsy compared to 24 weeks. However, the scores of steatosis, lobular inflammation, ballooning, and fibrosis stage improved at the third liver biopsy in 57%, 43%, 14%, and 29% of the patients, respectively, compared to pretreatment. One of the seven patients showed histopathological worsening at the third liver biopsy compared to pretreatment, but the improvement was maintained in the other six patients.

Conclusion The long-term treatment of NAFLD complicated by T2DM using an SGLT2i is associated with long-term improvement in liver histopathology despite the worsening of clinical features.

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© 2020 by The Japanese Society of Internal Medicine
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