Efecto del tratamiento con empagliflozina, un inhibidor del transportador sodio-glucosa 2, en la enfermedad hepática metabólica en pacientes con diabetes mellitus tipo 2

Resumen

NTRODUCTION AND AIM: Metabolic dysfunction-associated fatty liver disease (MAFLD) is characterized by excessive accumulation of fat in the liver. Diabetes mellitus type 2 is a risk factor that influences the development of hepatic steatosis and the progression to steatohepatitis and fibrosis. Despite being a highly prevalent disease, there is currently no drug with an approved indication for its treatment. There is some evidence to suggest a beneficial effect of sodium-glucose cotransporter 2 inhibitor in the treatment of MAFLD, however, more studies are needed to confirm these findings. The main objective of this study is to analyze whether the degree of liver stiffness, measured by ARFI/VTQ elastography, in patients with DM 2 and MAFLD improves after treatment with empagliflozin for 6 months. MATERIAL AND METHODS: Prospective observational study (before-after study) in patients with DM2 and MAFLD who were going to start treatment with empagliflozin according to usual clinical practice, carried out in Health Area VI of the Region of Murcia. Data collection was gathered prospectively, on the first visit, elastography was performed and the rest of the variables were collected. At 6 months, control elastography was performed and the variables were collected again. All patients included in the study received the intervention. RESULTS: 31 patients with type 2 DM and MAFLD with significant fibrosis (>5.7 KpA measured by ARFI/VTQ elastography) were included. At 6 months of empagliflozin treatment, liver stiffness levels improved significantly from 20.22 ± 14.37 to 7.8 ± 10.79 KpA (p < 0.001) and from 2.45 ± 0.86 to 1.39 ± 0.82 m/s (p < 0.001). Fibrosis resolved in 76.7% of patients and 83.3% improved at least one stage on the fibrosis scale. We also found significant improvement in weight from 95.82 ± 20 to 90.18 ± 19.65 kg (p <0.001), in BMI from 36.38 ± 6.1 to 34.16 ± 6.19 kg/m2, (p <0.001), in abdominal circumference from 120.80 ± 15.46 cm to 114.23 ± 15.47 cm, (p <0.001), in fat mass from 43.94 ± 17.29 to 40.44 ± 17.25 kg, (p <0.01), in total body water from 37.87 ± 10.16 to 36.05 ± 9.61 kg, (p <0.05), in SBP from 144.30 ± 21, 03 to 136.17 ±17.82 mmHg, (p <0.05), in GOT from 31.07 ± 14.32 to 25.3 ±12.7 U/L (p <0.01), in GTP from 38.77 ± 24.34 to 29.07 ± 17.65 U/L (p <0.01), in glucose 15 0.9 ± 64.15 to 116.20 ± 39.21 mg/dl (p<0.001), in HbA1c from 7.32 ± 1.28 to 6.24 ± 0.64% (p<0.001), in HOMA-IR from 6.97 ± 6.53 to 4.87 ± 5.38 (p<0.05), in ferritin from 108.17 ± 115.15 to 65.76 ± 50.54 ng/ml (p<0.01) and in uric acid from 4.86 ± 1.26 to 4.22 ± 1.01 mg/dl (p<0.01). CONCLUSIONS: In our study, treatment with empagliflozin improved fibrosis as measured by ARFI/VTQ elastography in patients with MAFLD and type 2 DM with significant fibrosis. Empagliflozin has an important role in liver pathophysiology and is independent of glycemic effects and weight improvement. Routine screening for significant fibrosis should be included in all patients with type 2 DM and MAFLD, and if fibrosis is altered, consider starting treatment with empagliflozin.