P-96 LONG-TERM PIOGLITAZONE TREATMENT AND LIVER STIFFNESS IN MASLD PATIENTS: INSIGHTS FROM A MULTICENTRIC STUDY

No Pioglitazone, an agonist of peroxisome proliferator-activated receptor gamma, has shown efficacy in improving indirect markers of liver steatosis, inflammation, and fibrosis. It also addresses systemic and adipose tissue insulin resistance in patients with type 2 diabetes and metabolic dysfunction-associated fatty liver disease (MASLD). This study aims to evaluate whether sustained consumption of pioglitazone over 12-24 months can improve liver stiffness in individuals diagnosed with biopsy- proven metabolic dysfunction-associated steatohepatitis (MASH). Retrospective data from 56 MASLD patients who received pioglitazone treatment for 12-24 months (15-30 mg daily) were gathered from three public hospitals in Brazil. Vibration-controlled transient elastography [VCTE (Fibroscan TM )] was performed before and after pioglitazone treatment as a non-invasive method to monitor disease progression. Additionally, a thorough analysis of both laboratory and clinical data was conducted. Most participants were female (63%, n = 35) and obese (BMI 31.1 ± 5.2) with a mean age of 58.4 ± 11.4 years. Initially, participants mostly had hypertension (71%, n = 40) and type II diabetes (61%, n = 34). During the second evaluation, the number of subjects with dyslipidemia and statin use increased. Initially, the liver stiffness measurement (LSM) median was 8.1 kPa (Min: 2.8; Max: 35.3) and 7.2 kPa (Min: 3.5; Max: 32.9) at the second evaluation. Prolonged pioglitazone treatment demonstrated LSM attenuation in 63% of cases (n = 35), resulting in an absolute reduction ranging from 0.1 to 14.4 kPa and a relative reduction ranging from 1.25% to 40.8%. Further analysis comparing the group with improved versus the group with worsened liver stiffness showed a decrease in the CAP parameter, FAST score, and levels of ALT, AST, GGT, TG, and ferritin. The administration of pioglitazone for 12 to 24 months effectively reduced hepatic inflammation and enhanced VCTE parameters in 63% of cases.