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Empagliflozin reduces liver fat in patients with type 2 diabetes, NAFLD

Ambrish Mithal
Ambrish Mithal

CHICAGO — Empagliflozin, an oral SGLT2 inhibitor, may provide substantial benefit to patients with type 2 diabetes and nonalcoholic fatty liver disease by aiding in the reduction of liver fat, according to findings from the E-LIFT trial presented here.

“NAFLD can progress to [nonalcoholic steatohepatitis], and subsequently to cirrhosis and even cancer of the liver, potentially fatal conditions. NAFLD is particularly common in diabetes. Medications to treat NAFLD/NASH are sorely needed,” Ambrish Mithal, MD, chair of the division of endocrinology and diabetes at Medanta The Medicity Hospital in Gurugram, India, told Endocrine Today. “Our study has shown an added benefit of liver fat reduction with [empagliflozin] — something that has not been shown earlier. This can potentially have direct clinical implications in the prevention of chronic liver disease in diabetes.”

The prospective, open-label, randomized, controlled E-LIFT trial enrolled 50 patients with type 2 diabetes and NAFLD to evaluate the effects of empagliflozin (Jardiance, Boehringer Ingelheim/Lilly) on liver fat reduction. Mithal and colleagues randomly assigned patients to empagliflozin 10 mg plus their standard medical treatment for type 2 diabetes or standard medical treatment only.

At 20 weeks, the addition of empagliflozin yielded substantial reductions in liver fat, as measured by MRI-derived proton density fat fraction, with a mean difference of 4% between the two groups (P < .0001). End-of-treatment MRI-derived proton density fat fraction was 11.3% vs. 16.2% at baseline in the empagliflozin group (P < .0001) and 15.5% vs. 16.4%, respectively, in the standard-treatment group (P = .057).

The researchers also observed a significant between-group difference in alanine aminotransferase (–10.9 IU/L, P = 0.005) and nonsignificant difference in aspartate aminotransferase (–7.7 IU/L; P = .212) and gamma-glutamyl transpeptidase (–11 IU/L; P = .057) over the study period.

At the end of the trial, there were no significant differences in fasting plasma glucose or HbA1c after treatment with empagliflozin or standard care.

“While our findings do not prove that empagliflozin will help treat NAFLD or prevent NASH, the initial results are promising and open up the possibility that empagliflozin may provide additional benefits for patients with diabetes,” Mithal said in a press release. – by Melissa Webb

Reference:

Mithal A, et al. OR27-2. Presented at: The Endocrine Society Annual Meeting; March 17-20, 2018; Chicago.

Disclosures: The study was funded by the Endocrine and Diabetes Foundation India in New Delhi. Mithal reports he received speaker and consultancy fees from Boehringer Ingelheim.

Ambrish Mithal
Ambrish Mithal

CHICAGO — Empagliflozin, an oral SGLT2 inhibitor, may provide substantial benefit to patients with type 2 diabetes and nonalcoholic fatty liver disease by aiding in the reduction of liver fat, according to findings from the E-LIFT trial presented here.

“NAFLD can progress to [nonalcoholic steatohepatitis], and subsequently to cirrhosis and even cancer of the liver, potentially fatal conditions. NAFLD is particularly common in diabetes. Medications to treat NAFLD/NASH are sorely needed,” Ambrish Mithal, MD, chair of the division of endocrinology and diabetes at Medanta The Medicity Hospital in Gurugram, India, told Endocrine Today. “Our study has shown an added benefit of liver fat reduction with [empagliflozin] — something that has not been shown earlier. This can potentially have direct clinical implications in the prevention of chronic liver disease in diabetes.”

The prospective, open-label, randomized, controlled E-LIFT trial enrolled 50 patients with type 2 diabetes and NAFLD to evaluate the effects of empagliflozin (Jardiance, Boehringer Ingelheim/Lilly) on liver fat reduction. Mithal and colleagues randomly assigned patients to empagliflozin 10 mg plus their standard medical treatment for type 2 diabetes or standard medical treatment only.

At 20 weeks, the addition of empagliflozin yielded substantial reductions in liver fat, as measured by MRI-derived proton density fat fraction, with a mean difference of 4% between the two groups (P < .0001). End-of-treatment MRI-derived proton density fat fraction was 11.3% vs. 16.2% at baseline in the empagliflozin group (P < .0001) and 15.5% vs. 16.4%, respectively, in the standard-treatment group (P = .057).

The researchers also observed a significant between-group difference in alanine aminotransferase (–10.9 IU/L, P = 0.005) and nonsignificant difference in aspartate aminotransferase (–7.7 IU/L; P = .212) and gamma-glutamyl transpeptidase (–11 IU/L; P = .057) over the study period.

At the end of the trial, there were no significant differences in fasting plasma glucose or HbA1c after treatment with empagliflozin or standard care.

“While our findings do not prove that empagliflozin will help treat NAFLD or prevent NASH, the initial results are promising and open up the possibility that empagliflozin may provide additional benefits for patients with diabetes,” Mithal said in a press release. – by Melissa Webb

Reference:

Mithal A, et al. OR27-2. Presented at: The Endocrine Society Annual Meeting; March 17-20, 2018; Chicago.

Disclosures: The study was funded by the Endocrine and Diabetes Foundation India in New Delhi. Mithal reports he received speaker and consultancy fees from Boehringer Ingelheim.

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