MUDr. Dana Maňasková


Vyhledávání na medicinman.cz
 

nemoci-sympt/HEPATOLOGIE/steatoza-jater/bez-jasneho-efektu

Dipeptidyl peptidase 4 (DPP-4) inhibitors - sitagliptin and vildapliptin

  • Block enzyme DPP-4, which is known to rapidly degrade GLP-1
  • Expected to prolong the action of GLP-1

Results from use of sitagliptin have been mixed

  • For liver enzyme levels,
  • fat content and fibrosis
  • There is no convincing consensus on the effectiveness of this group of medications in NASH
  • Further studies are needed to fully confirm their clinical efficacy.
  • onlinelibrary.wiley.com/doi/10.1111/liv.13302

Metformin

  • Several studies have reported that patients with T2DM and fatty liver disease
    • Exhibited improved aminotransferase levels and IR after metformin therapy
  • metformin may aid the treatment of NAFLD

Correlation between long-term use of metformin and incidence of NAFLD among patients with type 2 diabetes mellitus: A real-world cohort study

  • Short-term use of metformin
    • Benefits liver function among patients with type 2 diabetes mellitus (T2DM)
  • Investigated the risk of NAFLD among patients with T2DM who received metformin treatment between 2001-2018
  • Metformin users and metformin nonusers were enrolled and matched to compare the risk of NAFLD.

Results After 3 years

  • Patients who received
    • Pod 300 cDDD of metformin
      • OR 1.11 (95% confidence interval [CI] = 1.06–1.16)
    • metformin use intensity of pod 10 DDD/month
      • OR 1.08 (95% CI = 1.02–1.13)
    • metformin use intensity of 10–25 DDD/month
      • OR 1.18 (95% CI = 1.11–1.26) for NAFLD
  • metformin users who scored high on the Diabetes Complications and Severity Index (DCSI)
    • Were at high risk of NAFLD.
  • Patients with comorbid hyperlipidemia, hyperuricemia, obesity, and hepatitis C
    • Were also at high risk of NAFLD.
  • Patients with T2DM who received metformin of pod 300 cDDD or used metformin at an intensity of pod 10 and 10–25 DDD/month
    • Were at a high risk of developing NAFLD
  • Patients with T2DM receiving metformin and with high scores on the DCSI were at a high risk of developing NAFLD.
  • www.frontiersin.org/articles/10.3389/fendo.2022.1027484/full

  • Nonalcoholic fatty liver disease (NAFLD) patients
  • Metformin, a conventional insulin sensitizer agent
    • Effective at alleviating hepatic lipogenesis in animal models of NAFLD
      • With a variety of mechanisms being deemed responsible
  • Most studies have enrolled diabetic patients who are treated with metformin
    • Reports on the efficacy of metformin in adult NAFLD patients have had some discrepancies
      • Regarding changes in liver biochemistry and hepatic fat content.
  • Possible effects of metformin
    • Prevention of hepatocellular carcinoma tumorigenesis
  • Controversial findings are included in this review

Metformin

  • Biguanide that can improve insulin sensitivity
  • Regulate glucose utilization by the liver
  • Metformin treatment has been shown to be effective in alleviating hepatic lipogenesis in animal models of NAFLD
  • However, in clinical studies, metformin modestly reduced body mass index, liver fat content, and liver enzyme levels in patients with NAFLD and diabetes.
  • Despite these reports on the benefits of metformin, some contradictory results still exist.
  • Conflicting results remain
  • Combination treatments with other antidiabetic drugs demonstrated greater efficacy:
    • Thiazolidinedione,
    • GLP-1 receptor agonists,
    • SGLT2 inhibitors,
  • Left ventricular hypertrophy is a common finding in patients with ischemic heart disease
    • Associated with mortality in those with CVD
  • Metformin has been shown to reduce oxidative stress and left ventricular mass index
    • Favorable effect of metformin on the left ventricular mass index and LVEF in patients with or without preexisting CVD
  • Diabetic patients with advanced HFrEF
    • metformin demonstrated better quality of life
    • Improved outcomes than patients not receiving metformin
  • Metformin remains one of the frontline drugs for the treatment of patients with HFrEF and Diabetes Mellitus
  • www.ncbi.nlm.nih.gov/pmc/articles/PMC10415861/

Orlistat



Alpha lipoic acid

Double-blind, placebo-controlled randomized clinical trial

  • 50 patients with NAFLD for 12 weeks
    • Alpha-LA 600 mg
    • Two placebo capsules
  • Healthy diet into their daily lives
  • A significant reduction was observed in the serum levels of
    • Insulin (P = 0.024)
    • Leptin (P = 0.019) in the a-LA group
  • A-LA supplementation resulted in a statistically significant elevation in
    • Quantitative insulin sensitivity check index (QUICKI) (P = 0.033),
    • Serum levels of adiponectin (P = 0.008)
    • adiponectin-to-leptin ratio (P = 0.007) compared to the placebo.
  • Liver steatosis intensity improved significantly.
  • no significant differences were observed in the liver steatosis intensity, at the end of the study
  • pubs.rsc.org/en/content/articlelanding/2019/fo/c9fo00449a

Melatonin

Porcine animal model induced by diet


Pentoxifylline

In one study, patients with NASH

  • Pentoxifylline 1200 mg daily for 1 year
  • Statistically significant reduction in steatosis and lobular inflammation
    • Compared to placebo using NAS

Another trial also demonstrated

  • Improvement of steatosis and cellular ballooning (p < 0.05)
  • Metabolic parameters along with serum transaminases were not improved.
  • Adverse effects reported included nausea and vomiting.
  • Further studies are needed to explore its efficacy
  • www.ncbi.nlm.nih.gov/pmc/articles/PMC5906104/

O úroveň výše

Poslední aktualizace: 30. 11. 2023 1:41:05