Efficacy and Safety of Empagliflozin on Nonalcoholic Fatty Liver Disease: A Systematic Review and Meta-Analysis

Abstract

ObjectiveClinical trials have recently shown a connection between nonalcoholic fatty liver disease (NAFLD) and empagliflozin. This paper aimed at comprehensively assessing the effectiveness and security of empagliflozin in NAFLD patients.MethodsPubMed, Embase, Web of Science, Cochrane Library, CNKI, CBM, Wan-Fang digital database, VIP, and WHO ICTRP were searched for randomized controlled trials (RCTs) on the role of empagliflozin in NAFLD from inception to November 2, 2021. For continuous dating, we used values of mean differences (MD) to present.ResultsA total of four articles involving 244 NAFLD patients were included. Compared with the control group, empagliflozin could significantly reduce the body mass index (BMI) (MD: −0.98 [95% CI: −1.87, −0.10], p = 0.03), liver stiffness measurement (LSM) (MD: 0.49 [95% CI: −0.93, −0.06], p = 0.03), aspartate aminotransferase (AST) (MD: −3.10 [95% CI: −6.18, −0.02], p = 0.05), homeostasis model assessment of insulin resistance (HOMA-IR) (MD: −0.45 [95% CI: −0.90, 0.00], p = 0.05) of the treatment group.ConclusionsEmpagliflozin can improve body composition, insulin resistance, and liver fibrosis and decrease the hepatic enzymes in patients with NAFLD. Empagliflozin emerges as a new option for treating patients with NAFLD. However, further research shall determine the efficacy and safety of empagliflozin in NAFLD.

Impact of NAFLD and its pharmacotherapy on lipid profile and CVD

“…Inhibition of SGLT2 increases urinary glucose excretion by inhibiting glucose reabsorption, thereby reducing plasma glucose levels and body weight [141]. SGLT2 inhibitors, a novel oral hypoglycemic agent, have attracted increasing attention for NAFLD treatment [142,143]. In preclinical studies on rodent models, SGLT2 inhibitors significantly reduce body weight while improving hepatic steatosis and fibrosis [144,145].…”

To Do One and To Get More: Part II. Diabetes and metabolic dysfunction-associated fatty liver diseases

“…Therefore, MRI-PDFF or high-resolution magnetic resonance spectroscopy (H-MRS), another choice of noninvasive tool may be needed based on its potential surrogate for histologic improvement, 107 although it may be still underestimated in patients with advanced fibrosis, and defect by high cost and limited availability leading to limit the routine clinic use of MRI-PDFF. 104,105 Although these noninvasive diagnostic tools have received increasing attention, based on the absence of consensus scoring system, 101,102 the definite diagnostic procedure, such as an invasive procedure, may be needed. That is why the AASLD still recommends high-risk patients, such as patients with MeS (of course, DM is included) should be considered for liver biopsy for the identification of severity of MAFLD and offering the better chance to slow or cease the progression of MAFLD.…”

Interplay between metabolic dysfunction-associated fatty liver disease and chronic kidney disease: Epidemiology, pathophysiologic mechanisms, and treatment considerations

“…Additionally, dapagliflozin reduced liver fat accumulation in male NIH mice on a high-fat diet by acting on the AMPK/mTOR pathway[ 117 ]. Moving to clinical evidence, empagliflozin may lessen liver fibrosis, insulin resistance, and hepatic enzyme concentrations, as shown by the systematic review and meta-analysis of Zhang et al [ 118 ]. An interesting study on the importance of SGLT2 inhibition in MAFLD was performed by Akuta et al [ 73 ], who retrospectively reviewed patients with T2DM and FLD initiated on canagliflozin with consequent biopsy results over a period of 5 years.…”