SGLT2 inhibitors in diabetic biopsy proven MASH patients: A systematic review and meta-analysis.

In 30 seconds

This systematic review and random-effects, single-arm meta-analysis assessed SGLT2 inhibitors in patients with diabetes and biopsy-proven MASH. Seven trials contributed 110 patients receiving the intervention. Compared with baseline, pooled measures improved across liver enzymes, imaging and biopsy outcomes, and selected metabolic and cardiometabolic measures. The standardized mean change for biopsy NAFLD Activity Score was -1.18 (95% CI: -2.29 to -0.06). The authors reported that treatment was well tolerated, but noted limited certainty and substantial heterogeneity for some outcomes.

Key findings

• Biopsy NAFLD Activity Score improved from baseline: SMCR -1.18 (95% CI: -2.29 to -0.06).
• Controlled attenuation parameter improved: SMCR -0.56 (95% CI: -0.75 to -0.36).
• Liver stiffness measurement improved: SMCR -0.58 (95% CI: -1.03 to -0.14), with substantial heterogeneity.
• Pooled analyses also found improvements in liver enzymes, biopsy steatosis, ballooning and fibrosis, waist circumference, ferritin, and systolic blood pressure.

Why it matters

Biopsy-proven MASH is a clinically important liver disease, and these findings suggest SGLT2 inhibitors may have hepatic as well as metabolic effects in patients with concurrent diabetes. However, the evidence is based on small single-arm trial groups and within-group changes, so it does not establish comparative efficacy or show that the observed improvements translate into fewer clinical complications.

What to keep in mind

Only seven trials and 110 intervention-arm patients were included. The single-arm design assessed change from baseline rather than comparative treatment effects, and substantial heterogeneity affected liver stiffness and histological outcomes.