Abstract | BACKGROUND & AIMS: METHODS: We performed a prospective study of adults with biopsy-proven NASH (52 with type 2 diabetes and 49 with prediabetes), enrolled from the general population of San Antonio, Texas, from 2008 through 2014. After a run-in period of approximately 4 weeks, when all baseline measurements were made (liver magnetic resonance proton spectroscopy, euglycemic insulin clamp with glucose turnover measurements, dual-energy absorptiometry, and liver biopsy), subjects were randomly assigned to groups given pioglitazone or placebo (45 mg/d) for 18 months; all procedures performed at baseline were then repeated. The primary outcome was a reduction in nonalcoholic fatty liver disease activity score of 2 points or more (for at least 2 components) without worsening of fibrosis (and expressed as difference vs placebo). Secondary outcomes included NASH resolution, individual histologic components, intrahepatic triglyceride content (measured by 1H magnetic resonance spectroscopy), and insulin sensitivity (measured by euglycemic insulin clamp). RESULTS: The primary outcome was met by 48% of patients with type 2 diabetes vs 46% without diabetes. Resolution of NASH was achieved in 44% of patients with type 2 diabetes vs 26% without diabetes. A significant reduction in fibrosis, from baseline, was observed only in patients with type 2 diabetes (P = .035). Intrahepatic triglyceride content was reduced by 11% ± 2% in patients with diabetes vs a reduction of 9% ± 2% in patients without diabetes (P = .62); the plasma level of alanine aminotransferase was reduced by 50 ± 10 U/L in patients with diabetes vs a reduction of 36 ± 5 U/L in patients without diabetes (P = .22). Pioglitazone was associated with a significantly greater insulin sensitivity in adipose tissue of patients with diabetes vs without diabetes (P < .001), but nonsignificant differences in responses in hepatic (P = .49) and skeletal muscle (P = .32) insulin sensitivity. CONCLUSIONS:
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Authors | Fernando Bril, Srilaxmi Kalavalapalli, Virginia C Clark, Romina Lomonaco, Consuelo Soldevila-Pico, I-Chia Liu, Beverly Orsak, Fermin Tio, Kenneth Cusi |
Journal | Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association
(Clin Gastroenterol Hepatol)
Vol. 16
Issue 4
Pg. 558-566.e2
(04 2018)
ISSN: 1542-7714 [Electronic] United States |
PMID | 29223443
(Publication Type: Journal Article, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, Non-P.H.S.)
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Copyright | Copyright © 2018 AGA Institute. Published by Elsevier Inc. All rights reserved. |
Chemical References |
- Hypoglycemic Agents
- Placebos
- Protective Agents
- Pioglitazone
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Topics |
- Adolescent
- Adult
- Aged
- Biopsy
- Diabetes Mellitus, Type 2
(complications, drug therapy)
- Female
- Histocytochemistry
- Humans
- Hypoglycemic Agents
(administration & dosage)
- Liver
(pathology)
- Male
- Middle Aged
- Non-alcoholic Fatty Liver Disease
(complications, drug therapy)
- Pioglitazone
(administration & dosage)
- Placebos
(administration & dosage)
- Prospective Studies
- Protective Agents
(administration & dosage)
- Texas
- Treatment Outcome
- Young Adult
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