脂肪肝可考慮使用自費 SGLT2 inhibitor The efficacy of sodium-glucose transporter 2 inhibitors in patients with nonalcoholic fatty liver disease: A systematic review and meta-analysis

2026-01-07 10:26AM
最近遇到幾個脂肪肝患者. 有一些個案(無DM)自費使用 SGLT2 inhibitor, 一個使用 jardiance. 另一個使用 Canagliflozin (可拿糖/Invokana)
查詢了一下脂肪肝與 SGLT2 inhibitor 的文獻.
MASH= metabolic dysfunction-associated steatohepatitis 非酒精性脂肪肝炎

參考資料1
uptodate -Management of metabolic dysfunction-associated steatotic liver disease (nonalcoholic fatty liver disease) in adults 節錄裡面一段關於 forxiga 的敘述


脂肪肝炎患者使用安慰劑. 20% 纖維化會自然改善. 8% 肝指數會改善



Dapagliflozin – The sodium-glucose cotransporter 2 inhibitor dapagliflozin improves liver histology in patients with MASH. In a randomized trial of 154 patients with biopsy-proven MASH of any fibrosis stage, dapagliflozin 10 mg daily for 48 weeks resulted in improvement in fibrosis without worsening of steatohepatitis compared with placebo (45 versus 20 percent) [52]. MASH resolved without worsening of fibrosis in 23 versus 8 percent.

參考資料2
這篇統合分析(或稱薈萃分析)收錄的臨床研究使用的藥物是 dapagliflozin (Forxiga)(n = 5篇), empagliflozin(Jardiance) (n = 4篇), and ipragliflozin(台灣沒有. 主要是日本及美國使用) (n = 2篇)



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

Abstract
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).