Role of sodium-glucose cotransporter 2 inhibitors in liver diseases

Table 1 Studies on the effect of sodium-glucose cotransporter 2 inhibitors on liver stiffness and fibrosis as assessed by elastography or biopsy in patients with metabolic dysfunction-associated steatotic liver disease

Ref.	Country, study design	No. of patients	Male sex/age, in years/DM	Drug	Method of assessment	Outcome
Shimizu et al[36], 2019	Japan, RCT	33	57.6%/56.2 ± 11.5/100%	Dapaglifozin for 24 weeks	Transient elastography	LSM was nonsignificantly decreased after 24 weeks in the dapagliflozin group (9.5 ± 6.0 kPa to 8.0 ± 5.8 kPa, P = 0.0539) but significantly reduced in the subgroup of patients with baseline LSM ≥ 8.0 kPa (14.7 ± 5.7 kPa to 11.0 ± 7.3 kPa, P = 0.0158)
		24	62.5%/57.1 ± 13.8/100%	Placebo
Akuta et al[45], 2020	Japan, retrospective	7	71.4%/44-64/100%	Canagliflozin for 1 year	Liver biopsy	≥ 1 point improvement in fibrosis was observed in 2 (29%) at 6 months and 2 (29%) at 1 year (total 3 patients)
Taheri et al[29], 2020	Iran, RCT	43	65.1%/43.8 ± 9.7/0%	Empaglifozin for 24 weeks	Transient elastography	LSM was significantly decreased at 24 weeks in the empagliflozin group from baseline (6.0 ± 1.4 kPa to 5.3 ± 1.1 kPa, P = 0.001) but not in the placebo group
		47	46.8%/44.1 ± 9.3/0	Placebo
Chehrehgosha et al[26], 2021	Iran, RCT	35	42.9%/50.5 ± 8.4/100%	Empaglifozin for 24 weeks	Transient elastography	LSM was significantly decreased after 24 weeks in the empagliflozin group (LSM: 6.8 ± 2.4 to 6.0 ± 1.6 kPa; P = 0.005) while the change in fibrosis score in the pioglitazone group and placebo groups were not significant
		34	50%/52.5 ± 7.9/100%	Pioglitazone
		37	37.8%/51.8 ± 7.8/100%	Placebo
Das et al[39], 2021	India, prospective	100	81%/44.1 ± 8.2/100%	Dapaglifozin for 24 weeks	Transient elastography	LSM was significantly reduced at 24 weeks (6.9 ± 1.4 kPa at baseline to 6.0 ± 1.4 kPa; P = 0.001)
Pokharel et al[25], 2021	Nepal, prospective	84	81%/47.2 ± 10.0/100%	Empaglifozin	Transient elastography	There was a significant reduction in the LSM from 5.9 ± 4.2 kPa to 5.0 ± 1.5 kPa (P = 0.001)
Koullias et al[49], 2024	Greece, prospective	25	72%/63.2 ± 1.4/	Empaglifozin for 52 weeks	2D-shear wave elastography	There was significant reduction in stiffness from 7.1 ± 0.9 kPa to 6.9 ± 1.6 kPa (P = 0.046) in the empagliflozin group but not with dulaglutide or placebo
		25	84%/54.4 ± 2.5/100%	Dulaglutide for 52 weeks
		28	60.7%/55 ± 2.4/100%	Placebo
Stratina et al[48], 2024	Romania, prospective	92	45.7%/61.5 ± 11.2/100%	Dapagliflozin for 24 weeks	Transient elastography	LSM reduced significantly from 8.1 ± 2.9 kPa to 6.5 ± 3.1 kPa (P < 0.001) with semaglutide but not with (8.2 ± 3.1 kPa to 7.9 ± 2.9 kPa, P = 0.074)
		95	45.3%/56.0 ± 9.8/100%	Semaglutide for 24 weeks
Weng et al[24], 2024	Taiwan, RCT	69	57.3%/51 ± 12.6/9.3%	Dapagliflozin for 24 weeks	Transient elastography	Both groups exhibited reductions in LSM from baseline (control group: From 5.4 ± 2.3 to 4.5 ± 1.2 kPa, P = 0.002; dapagliflozin group: From 5.4 ± 2.0 to 4.1 ± 1.0, P < 0.001); however, the between-group difference did not reach statistical significance (P = 0.08)
		62	50.7%/52 ± 12/17.3%	Placebo

2D: Two-dimensional; DM: Diabetes mellitus; LSM: Liver stiffness measurement; RCT: Randomized controlled trial.