Mantovani Alessandro, Petracca Graziana, Csermely Alessandro, Beatrice Giorgia, Targher Giovanni
Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona, 37126 Verona, Italy.
Metabolites. 2020 Dec 30;11(1):22. doi: 10.3390/metabo11010022.
Recent randomized controlled trials (RCTs) tested the efficacy of sodium-glucose cotransporter-2 (SGLT-2) inhibitors to specifically treat nonalcoholic fatty liver disease (NAFLD). We systematically searched three electronic databases (up to 31 October 2020) for identifying placebo-controlled or head-to-head RCTs that used SGLT-2 inhibitors for treatment of NAFLD. No published RCTs with paired liver biopsy data were available for the meta-analysis. Primary outcome measures were changes in serum liver enzyme levels and liver fat content on imaging techniques. Overall, we included a total of twelve RCTs testing the efficacy of dapagliflozin ( = six RCTs), empagliflozin ( = three RCTs), ipragliflozin ( = two RCTs) or canagliflozin ( = one RCT) to specifically treat NAFLD for a median period of 24 weeks with aggregate data on 850 middle-aged overweight or obese individuals with NAFLD (90% with type 2 diabetes). Compared to placebo/reference therapy, treatment with SGLT-2 inhibitors significantly decreased serum alanine aminotransferase (weighted mean differences (WMD): -10.0 IU/L, 95%CI -12.2 to -7.79 IU/L; = 10.5%) and gamma-glutamyltransferase levels (WMD: -14.49 IU/L, 95%CI -19.35 to -9.63 IU/L, = 38.7%), as well as the absolute percentage of liver fat content on magnetic resonance-based techniques (WMD: -2.05%, 95%CI -2.61 to -1.48%; = 0%). In conclusion, SGLT-2 inhibitors seem to be a promising treatment option for NAFLD.
近期的随机对照试验（RCT）检验了钠-葡萄糖协同转运蛋白2（SGLT-2）抑制剂专门治疗非酒精性脂肪性肝病（NAFLD）的疗效。我们系统检索了三个电子数据库（截至2020年10月31日），以识别使用SGLT-2抑制剂治疗NAFLD的安慰剂对照或头对头RCT。没有可用于荟萃分析的已发表的有配对肝活检数据的RCT。主要结局指标是血清肝酶水平的变化以及成像技术检测的肝脏脂肪含量。总体而言，我们共纳入了12项RCT，这些试验检验了达格列净（=6项RCT）、恩格列净（=3项RCT）、依帕列净（=2项RCT）或卡格列净（=1项RCT）专门治疗NAFLD的疗效，中位治疗期为24周，汇总了850名患有NAFLD的中年超重或肥胖个体（90%患有2型糖尿病）的数据。与安慰剂/对照疗法相比，使用SGLT-2抑制剂治疗可显著降低血清丙氨酸氨基转移酶（加权平均差（WMD）：-10.0 IU/L，95%CI -12.2至-7.79 IU/L；P=10.5%）和γ-谷氨酰转移酶水平（WMD：-14.49 IU/L，95%CI -19.35至-9.63 IU/L，P=38.7%），以及基于磁共振技术的肝脏脂肪含量的绝对百分比（WMD：-2.05%，95%CI -2.61至-1.48%；P=0%）。总之，SGLT-2抑制剂似乎是NAFLD一种有前景的治疗选择。
