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GLP-1 Analog May Help with NAFLD and Nonalcoholic Steatohepatitis

GLP-1 drug shows potential to treat both diseases…

Nonalcoholic fatty liver disease (NAFLD), the most common form of chronic liver disease in America which affects approximately 30% of the population, is known to contribute to prediabetes and diabetes due to the liver’s important role in the regulation of blood sugar throughout the body. Up to 25% of the patients with NAFLD are also suffering from the more severe inflammatory condition known as nonalcoholic steatohepatitis (NASH). NASH is often hard to diagnose, and is often missed in routine blood work and physical exams.

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The glucagon-like peptide 1 analog liraglutide (Victoza, Novo Nordisk) was recently shown to eradicate non-alcoholic steatohepatitis in greater than a third of patients in a phase 2 study. The primary endpoint in the Liraglutide Efficacy and Action in Nonalcoholic Steatohepatitis (LEAN) 48-week, double blinded, placebo-controlled trial was the resolution of definite nonalcoholic steatohepatitis and no worsening in fibrosis.

The endpoint was achieved in nine of twenty-three (39%) overweight patients with nonalcoholic steatohepatitis who received liraglutide compared to just two of the twenty two patients (9%) who received placebo. The patients who received liraglutide, unsurprisingly, experienced weight loss and improved fasting glucose levels.

Although the primary endpoint of the trial was achieved, this was only a phase 2 trial with a small population. The purpose of the trial was not to compare the effectiveness of liraglutide against the placebo, but rather gain insight into whether liraglutide was effective in the treatment of NASH.

Practice Pearls:

  • Diagnosis of NAFLD is often complicated and underdiagnosed.
  • There is a strong correlation between fatty liver disease and central obesity and high levels of insulin resistance.
  • Although more expansive studies need to be performed, GLP-1 analogue liraglutide may be a potential choice of treatment for a patient suffering from diabetes who is also found to have non-alcoholic fatty liver disease.

“Two Diabetes Drugs May Ease Fatty Liver.” European Association for the Study of the Liver (EASL) International Liver Congress 2015: Abstract 0047. Presented April 23, 2015.