The efficacy of sodium-glucose transporter 2 inhibitors in patients with nonalcoholic fatty liver disease: A systematic review and meta-analysis

• Published in: Pharmacological research Vol. 213; p. 107647
• Main Authors: Li, Hongsheng, Hou, Yanli, Xin, Wenyong, Ding, Lina, Yang, Ying, Zhang, Yikun, Wu, Wenqi, Wang, Zhibin, Ding, Wenyu
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.03.2025; Elsevier
• Subjects: Blood Glucose - drug effects; Blood Glucose - metabolism; Humans; Liver - drug effects; Liver - metabolism; Liver enzymes; Meta-analysis; Non-alcoholic Fatty Liver Disease - blood; Non-alcoholic Fatty Liver Disease - drug therapy; Nonalcoholic fatty liver disease; Sodium-glucose transporter 2 inhibitors; Sodium-Glucose Transporter 2 Inhibitors - adverse effects; Sodium-Glucose Transporter 2 Inhibitors - therapeutic use; Treatment Outcome; T2DM; NAFLD; AST; LDL-C; CI; HCC; ALT; NASH; SGLT-2; TC; Meta-analysis; HDL-C; MAFLD; Sodium-glucose transporter 2 inhibitors; TG; GGT; RCTs; Liver enzymes; Nonalcoholic fatty liver disease
• ISSN: 1043-6618; 1096-1186; 1096-1186
• DOI: 10.1016/j.phrs.2025.107647

The efficacy of sodium-glucose transporter 2 (SGLT-2) inhibitors for nonalcoholic fatty liver disease (NAFLD) is unclear. Therefore, we conducted a systematic review and meta-analysis to evaluate SGLT-2 inhibitors efficacy for NAFLD treatment. We systematically searched major electronic databases (PubMed, Cochrane Library, Web of Science, Embase) from inception until 11/2023, identifying randomized controlled trials (RCTs) of SGLT-2 inhibitors treatment for patients with NAFLD. The mean differences (MD or SMD) and 95 % confidence intervals (CIs) were calculated via random-effects models. Eleven articles (n = 805 patients with NAFLD) were included in this study. Of these, 408 participants received SGLT-2 inhibitors, while 397 participants were in the control group. SGLT-2 inhibitors significantly reduced liver enzyme levels, including aspartate alanine aminotransferase (ALT) (MD [95 % CI]; −9.31 U/L [-13.41, −5.21], p < 0.00001), aspartate aminotransferase (AST) (MD [95 % CI]; −6.06 U/L [-10.98, −1.15], p = 0.02), and gamma-glutamyltransferase (GGT) (MD [95 % CI]; −11.72 U/L [-15.65, −7.80], p < 0.00001). SGLT-2 inhibitors intervention was also associated with significant reductions in body weight (MD [95 % CI]; −2.72 kg [-3.49, −1.95], p < 0.00001) and BMI (MD [95 % CI]; −1.11 kg/m2 [-1.39, −0.82], p < 0.00001) and improvements in glycaemic indices, triglyceride (TG) and high-density lipoprotein cholesterol (HDL-C). However, no significant changes in total cholesterol (TC) or low-density lipoprotein cholesterol (LDL-C) were observed. The meta-analysis revealed a beneficial effect of SGLT-2 inhibitors on liver functions and body weight, BMI, TG, HDL-C, and glucose homeostasis in patients with NAFLD, indicating that SGLT-2 inhibitors might be a clinical therapeutic strategy for these patients, especially individuals with concurrent type 2 diabetes mellitus (T2DM). [Display omitted]