What is the role of Empagliflozin in MASLD ?

Title of the Article:

Effect of Empagliflozin on Liver Fat in Patients With Type 2 Diabetes and Nonalcoholic Fatty Liver Disease: A Randomized Controlled Trial (E-LIFT Trial)

First Two Authors Followed by et al.:

Mohammad Shafi Kuchay, Sonal Krishan et al.

One-Line Summary of the Article:

This randomized controlled trial demonstrated that empagliflozin significantly reduces liver fat and improves ALT levels in patients with type 2 diabetes and nonalcoholic fatty liver disease (NAFLD).

Six Key Points from the Article:

1. Study Objective: Investigated the effect of empagliflozin (SGLT-2 inhibitor) on liver fat in type 2 diabetes and NAFLD using MRI-proton density fat fraction (MRI-PDFF).
2. Study Design: A 20-week, open-label, randomized controlled trial with 50 patients, comparing empagliflozin (10 mg/day) plus standard diabetes treatment vs. standard treatment alone.
3. Primary Outcome: Empagliflozin significantly reduced liver fat (MRI-PDFF decrease from 16.2% to 11.3%; p < 0.0001), while the control group showed a nonsignificant reduction (16.4% to 15.5%; p = 0.057).
4. Liver Enzymes: ALT levels decreased significantly with empagliflozin (p = 0.005), whereas changes in AST (p = 0.212) and GGT (p = 0.057) were nonsignificant.
5. Glycemic Control Maintained: Both groups had comparable reductions in fasting glucose and HbA1c, suggesting the liver fat reduction was independent of glycemic improvement.
6. Safety Profile: Empagliflozin was well-tolerated, though a few patients experienced mild adverse effects, including balanoposthitis, fatigue, and joint pain.

Practical Take-Home Message:

Empagliflozin, in addition to standard diabetes therapy, significantly reduces liver fat and improves ALT levels in patients with type 2 diabetes and NAFLD. These findings support its potential role in managing NAFLD alongside glycemic control.

Citation (Vancouver Format):

Kuchay MS, Krishan S, Mishra SK, Farooqui KJ, Singh MK, Wasir JS, et al. Effect of Empagliflozin on Liver Fat in Patients With Type 2 Diabetes and Nonalcoholic Fatty Liver Disease: A Randomized Controlled Trial (E-LIFT Trial). Diabetes Care. 2018;41(8):1801–1808. doi:10.2337/dc18-0165