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- Title
Benefits of combining SGLT2 inhibitors and pioglitazone on risk of MASH in type 2 diabetes—A real‐world study.
- Authors
Lee, Chi‐Ho; Lui, David Tak‐Wai; Mak, Lung‐Yi; Fong, Carol Ho‐Yi; Chan, Kylie Sze‐Wing; Mak, Jimmy Ho‐Cheung; Cheung, Chloe Yu‐Yan; Chow, Wing‐Sun; Woo, Yu‐Cho; Yuen, Man‐Fung; Seto, Wai‐Kay; Lam, Karen Siu‐Ling
- Abstract
Aims: Both pioglitazone and glucagon‐like peptide 1 receptor agonists (GLP1RA) alone improve metabolic dysfunction‐associated steatohepatitis (MASH) in randomized clinical trials, whereas preclinical studies suggested MASH benefits with sodium glucose co‐transporter 2 inhibitors (SGLT2i). In the real world, patients with type 2 diabetes often require multiple agents for glycaemic control. Here, we investigated the benefits of combining these agents on risks of MASH. Materials and Methods: Longitudinal changes in FibroScan‐aspartate aminotransferase (FAST) score were measured in 888 patients with type 2 diabetes. Use of pioglitazone, GLP1RA and/or SGLT2i was defined as continuous prescriptions of ≥180 days prior to their last reassessment FibroScan. Multivariable logistic regression analysis was conducted to evaluate the associations between use of these agents and FAST score changes. Results: Over a median follow‐up of 3.9 years, the increasing number of these agents used was significantly associated with more reductions in FAST score (p for trend <0.01). Dual combination was independently associated with a higher likelihood of achieving low FAST score at reassessment than single use of any of these agents (odds ratio [OR] 2.84, p = 0.01). Among the different drug combinations, using SGLT2i and pioglitazone (median dose 15 mg daily) together, as compared to not using any of these three agents, was associated with a higher likelihood of both low FAST score at reassessment (OR 6.51, p = 0.008) and FAST score regression (OR 12.52, p = 0.009), after adjusting for changes in glycaemic control and body weight during the study. Conclusions: Combining SGLT2i and pioglitazone is a potentially useful strategy to ameliorate 'at‐risk' MASH in patients with type 2 diabetes.
- Subjects
TYPE 2 diabetes; GLYCEMIC control; REGULATION of body weight; LOGISTIC regression analysis; CLINICAL trials; SODIUM-glucose cotransporters
- Publication
Diabetes, Obesity & Metabolism, 2025, Vol 27, Issue 2, p574
- ISSN
1462-8902
- Publication type
Academic Journal
- DOI
10.1111/dom.16049