Empagliflozin Reduced Liver Fat in Type 2 Patients with Nonalcoholic Fatty Liver Disease

April 18, 2018

Diabetes drug empagliflozin reduces fat levels in type 2 patients, which may reduce risk of severe liver disease.

Empagliflozin, a treatment for type 2 diabetes patients, was found to reduce liver fat in patients with both diabetes and nonalcoholic fatty liver disease (NAFLD), according to the results of the E-LIFT Trial.

"We showed for the first time that empagliflozin reduced liver fat significantly in patients with type 2 diabetes and nonalcoholic fatty liver disease. We do not know yet whether treatment with empagliflozin reduces liver inflammation and prevents liver fibrosis," senior investigator Ambrish Mithal, MD, tells Drug Topics about the results.

According to the American Liver Foundation, NAFLD is the build-up of extra fat in liver cells that is not due to the use of alcohol. Mithal, who is chair of the Division of Endocrinology and Diabetes at Medanta  Hospital, Gurugram, India, says that about 60% to 75% of patients with type 2 diabetes have concomitant NAFLD.

It can have significant health consequences for those patients who develop the disease. "Presence of NAFLD in patients with type 2 diabetes is a risk factor for its progression to more severe liver disease like nonalcoholic steatohepatitis (NASH), liver fibrosis, cirrhosis, and in some patients even leads to hepatic cancer," he says.

NAFLD is also an independent risk factor for cardiovascular disease, chronic kidney disease, and cardiac arrhythmias.

Despite these health risks, there is no approved treatment for NAFLD. Treatment options such as diet and exercise, glitazones (pioglitazone), and GLP-1r agonists (liraglutide) have shown some promise but each treatment option also has individual treatment obstacles that have led to poor patient acceptability in the past.

Researchers wanted to explore whether SGLT-2 inhibitors, such as empagliflozin, could be a better treatment option.

During their study, they randomized 50 patients age 40 or older with both type 2 diabetes and NAFLD to either receive 10 mg of empagliflozin per day plus their normal treatment for type 2 diabetes, or to only receive their normal treatment for type 2 diabetes.

After following the patients for 20 weeks, the researchers found that those who had received empagliflozin had decreased their level of liver fat from 16.2% to 11.3%. The control group, however, only saw a reduction from 16.4% to 15.6%.

The results of the study suggest that SGLT-2 inhibitors could have significant potential in the treatment of NAFLD, however, before the full implications are fully understood larger and more long-term studies into their use are needed.

"This is the beginning," Mithal says. "We have a lot more questions about the role of SGLT-2 inhibitors in the treatment of NAFLD and in the prevention and consequences of NAFLD."