In this retrospective study, serial liver biopsy was performed to investigate the efficacy of sodium-glucose co-transporter-2 (SGLT2) inhibitor (SGLT2i) in patients with non-alcoholic steatohepatitis (NASH) complicated by type 2 diabetes mellitus. A total of three cases, wherein SGLT2i was introduced, were evaluated by examining liver histology obtained at three points, during pretreatment, 24 weeks after the start of the treatment, and 3 years or more after the start of the treatment. All of the three cases showed worsening condition upon physical examination. However, one of the three cases indicated worsening histological findings during the 3rd biopsy than at pretreatment, but the other two cases had maintained histological improvement. In conclusion, the long-term histological impacts of SGLT2i in patients with NASH showed various findings, regardless of worsening condition upon physical examination. Furthermore, large-scale prospective studies are needed to determine the long-term impact of SGLT2i on the histological features in patients with NASH.
