a Pharmacology Unit, Department of Medical and Surgical Sciences , University of Bologna , Bologna , Italy.
b Unit of Metabolic Diseases & Clinical Dietetics, Department of Medical and Surgical Sciences , University of Bologna , Bologna , Italy.
Expert Opin Pharmacother. 2018 Dec;19(17):1903-1914. doi: 10.1080/14656566.2018.1531126. Epub 2018 Oct 9.
Pharmacotherapy used to treat type 2 diabetes mellitus (T2DM) is facing a paradigm shift in clinical practice with recent cardiovascular (CV) outcome trials having a substantial impact on drug prescription with treatment having a more tailored approach. In patients with T2DM, the issue of chronic liver disease is multifaceted. However, a clinical evidence is emerging on the beneficial effect of antidiabetic medications on nonalcoholic fatty liver disease (NAFLD).
The authors provide a synopsis on the current and upcoming pharmacotherapy for NAFLD, including the challenges with their development, focusing on drugs for T2DM. Clinical data on the potential benefits and safety issues are assessed with the aim of proposing an individualized algorithm for patient management. Both MEDLINE and ClinicalTrials.Gov are used to derive the relevant information.
Considering the pivotal role of insulin resistance in NAFLD, insulin sensitizers should be the treatment of choice. Accordingly, pioglitazone is the only drug with a significant effect on liver fibrosis, the driver of disease progression and long-term outcome. Among new glucose-lowering drugs, glucagon-like-peptide 1 receptor agonists or sodium-glucose cotransporter type 2 inhibitors have shown positive effects in phase II studies and are qualifying as potential candidates for NAFLD treatment in diabetes.
治疗 2 型糖尿病（T2DM）的药物治疗在临床实践中正面临着模式转变，最近的心血管（CV）结局试验对药物处方产生了重大影响，治疗方法更加个体化。在 T2DM 患者中，慢性肝病问题是多方面的。然而，越来越多的临床证据表明，降糖药物对非酒精性脂肪性肝病（NAFLD）有益。
作者对目前和即将出现的 NAFLD 药物治疗进行了概述，包括其开发面临的挑战，重点关注 T2DM 的药物。评估了潜在益处和安全性问题的临床数据，旨在为患者管理提出个体化算法。使用 MEDLINE 和 ClinicalTrials.gov 来获取相关信息。
鉴于胰岛素抵抗在 NAFLD 中的关键作用，胰岛素增敏剂应该是首选治疗药物。因此，吡格列酮是唯一对肝纤维化有显著作用的药物，肝纤维化是疾病进展和长期预后的驱动因素。在新型降糖药物中，胰高血糖素样肽 1 受体激动剂或钠-葡萄糖共转运蛋白 2 抑制剂在 II 期研究中显示出积极效果，有资格成为糖尿病 NAFLD 治疗的潜在候选药物。
