Dapagliflozin may improve outcomes in patients with metabolic dysfunction-associated steatohepatitis

1. The use of dapagliflozin in patients with metabolic dysfunction-associated steatohepatitis (MASH) resulted in a higher proportion of improvement of MASH compared to placebo. 

Evidence Rating Level: 1 (Excellent)

Therapeutic options for MASH remain limited, with current management strategies focusing on the treatment of coexisting conditions such as type 2 diabetes mellitus (T2DM). While sodium-glucose cotransporter 2 (SGLT2) inhibitors are widely used in the management of T2DM and heart failure, their effectiveness in MASH remains unknown. This randomized controlled trial therefore sought to investigate the efficacy and safety of the SGLT2 inhibitor, dapagliflozin, in MASH. 154 patients (mean[SD] age, 35.1[10.2] years; 85% male) over the age of 18 with biopsy-confirmed MASH from 6 centres in China were randomized to receive dapagliflozin (n = 74) or placebo (n = 76). The primary outcome was MASH improvement (defined as a decrease in non-alcoholic fatty liver disease activity score [NAS] of at least 2 points). MASH improvement was observed in 53% of patients in the dapagliflozin group versus 30% in the placebo group (risk ratio 1.73 (95% CI 1.16 to 2.58); P=0.006), with a mean difference in NAS between the groups of -1.39 ((−1.99 to −0.79); P<0.001). The rate of adverse events was comparable between groups (56% in the dapagliflozin group compared to 64% in the placebo group). Overall, this study found that use of dapagliflozin patients with MASH resulted in a greater proportion of patients experiencing improvement of MASH compared to those receiving placebo. 

Click to read the study in BMJ

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