A retrospective study based on serial liver biopsies was performed to investigate the efficacy of sodium-glucose cotransporter 2 inhibitor (SGLT2i) for non-alcoholic steatohepatitis (NASH) complicated by type 2 diabetes mellitus. Three cases were evaluated for liver histology at four points until 5 years after the start of treatment. All three cases showed a reworsening on physical examination. One case did not show histological change at the fourth biopsy compared to pretreatment, but the other two cases maintained histological improvement. All cases did not develop three-point major adverse cardiovascular events (MACE). In conclusion, long-term treatment of SGLT2i for NASH is associated with long-term improvement in liver histopathology. Further large-scale prospective studies are needed to determine the long-term impact for histological features and outcomes, including three-point MACE.
