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SGLT-2is, including ipragliflozin, are an effective therapeutic modality for diabetes patients with NAFLD. Ipragliflozin is also effective in the resolution of NASH and in mediating obesity and glycemic control.

Sodium–glucose co-transporter 2 inhibitors (SGLT-2is) are widely used for the treatment of diabetes; however, the effect of SGLT-2is on non-alcoholic fatty liver disease (NAFLD) is uncertain. This multicenter randomized controlled trial, published in Hepatology Communications, evaluated the outcomes of SGLT-2is in patients with NAFLD. The study recruited participants with type 2 diabetes mellitus (T2DM) and NAFLD. Participants managed with and without SGLT-2is were compared for glycemic control, liver pathology, and obesity. The drug regime of SGLT-2is in the ipragliflozin (IPR) group (n = 25) constituted 50 mg ipragliflozin/day for 72 weeks. The control (CTR) group participants (n = 26) were administered insulin, pioglitazone, or glucagon-like peptide-1 analogs.
The controlled trial results revealed that NAFLD and diabetes patients in the IPR group demonstrated a significant decline in body mass index (BMI) and hemoglobin A1c (HbA1c). However, these changes were not observed in NAFLD and diabetes patients in the CTR group. Twenty-one participants of the IPR group and 25 participants of the CTR groups were also evaluated for liver pathology. Hepatic fibrosis at the baseline was discovered in 17 and 18 study participants in the IPR and CTR groups, respectively. Among IPR group participants 12/17 demonstrated improvement in hepatic fibrosis with ipragliflozin treatment. Hepatic fibrosis was also ameliorated in 4/18 of the CTR group participants who were not administered SGLT-2is. A total of 66.7% and 27.3% of the study participants in the IPR and CTR groups, respectively, demonstrated the resolution of non-alcoholic steatohepatitis (NASH); however, 33.3% of the participants in the CTR group developed NASH.
In summary, long-term treatment with ipragliflozin effectively treats NASH and may be effectively used for preventing and treating NASH in diabetes patients. Ipragliflozin is also helpful for improving obesity and glycemic control in diabetes patients with NAFLD.
Takahashi, H., Kessoku, T., Kawanaka, M., Nonaka, M., Hyogo, H., Fujii, H., . . . Anzai, K. (2022). Ipragliflozin Improves the Hepatic Outcomes of Patients With Diabetes with NAFLD. Hepatol Commun, 6(1), 120-132. https://doi.org/10.1002/hep4.1696

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