P1158 - SGLT-2 Inhibitors: A Therapeutic Avenue for Non-Alcoholic Fatty Liver Disease, Demonstrating Improvements in Imaging Biomarkers and Histological Features, Including Reduced Hepatic Fibrosis, and Ballooning

Arundhati Sharma, MBBS¹, Simranpreet Singh Daid, MBBS², Anubhuti Sharma, MBBS¹, Sarav Daid, MD^3
1Mayo Clinic Arizona, Kurukshetra, Haryana, India; ²Punjab Institute of Medical Sciences, Abohar, Punjab, India; ³New York Medical College, New York, NY

Introduction: Non-alcoholic fatty liver disease (NAFLD) is a major global health issue, significantly contributing to liver morbidity. Despite its prevalence, no universally approved pharmacological treatments are available. This study systematically reviews and meta-analyzes the efficacy of SGLT-2 inhibitors in reducing hepatic steatosis and fibrosis in NAFLD patients.

Methods: We conducted a comprehensive search of PubMed, Embase, Cochrane Library, ClinicalTrials.gov, Google Scholar, and CINAHL/EBSCOhost to find relevant studies up to May 2024. This meta-analysis included randomized controlled trials (RCTs) comparing SGLT-2 inhibitors with non-SGLT-2 inhibitors in NAFLD patients. Outcomes measured included controlled attenuation parameter (CAP), liver-to-spleen (L/S) ratio, liver proton density fat fraction (PDFF), liver stiffness measurement (LSM), FIB-4(fibrosis)index, and reductions in hepatocellular ballooning, hepatic steatosis, lobular inflammation, and liver fibrosis. Data extraction was systematic, and RevMan 5.4.1 was used for meta-analysis. The Cochrane Risk of Bias 2.0 tool assessed study bias. Data were synthesized as mean differences for continuous outcomes and risk ratios for dichotomous outcomes.

Results: A total of 20 eligible RCTs involving 1447 participants were analysed. The risk of bias ranged from low to moderate concerns. Significant improvements were observed in CAP(MD −10.60 dB/m, 95% CI [−18.28, −2.91], p=0.007),LSM (MD −0.67 kPa, 95% CI [−1.19, −0.16], p=0.010), PDFF (MD −2.61%, 95% CI [−5.05, −0.17], p=0.04),FIB-4 Index (MD −0.10, 95% CI [−0.19, −0.01], p=0.004),One-Score or One-Stage Reduction in Hepatocellular Ballooning(MD2.19, 95% CI [1.22, 3.94], p=0.009), One-Score or One-Stage Reduction in Liver Fibrosis (MD2.29, 95% CI [1.12, 4.68], p=0.02) post treatment. Insignificant differences were observed in L/S ratio (MD0.06, 95% CI [-0.05, 0.16], p=0.28), one-stage reduction in hepatic steatosis (MD 1.30, 95%CI [0.42, 4.05], p=0.65), one-stage reduction in lobular inflammation (MD1.80, 95%CI [0.53, 6.16], p=0.35)

Discussion: This meta-analysis shows that SGLT-2 inhibitors significantly improve hepatic steatosis and fibrosis in NAFLD patients. The evidence, supported by imaging and histopathology biomarkers, indicates a low to moderate certainty of therapeutic benefits. These findings highlight the potential of SGLT-2 inhibitors as viable treatments, emphasizing the need for further large-scale studies to confirm these results and establish standardized treatment protocols.



Disclosures:


Arundhati Sharma, MBBS¹, Simranpreet Singh Daid, MBBS², Anubhuti Sharma, MBBS¹, Sarav Daid, MD³. P1158 - SGLT-2 Inhibitors: A Therapeutic Avenue for Non-Alcoholic Fatty Liver Disease, Demonstrating Improvements in Imaging Biomarkers and Histological Features, Including Reduced Hepatic Fibrosis, and Ballooning, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.