Changes in liver steatosis and liver stiffness following Empagliflozin treatment in patients with MASLD and type 2 diabetes: A single‐arm pre–post study

BACKGROUND: Metabolic dysfunction-associated steatotic liver disease (MASLD) is common in subjects with type 2 diabetes mellitus (T2DM), being linked to a higher risk for the development of liver-related and cardiovascular diseases. Sodium-glucose cotransporter 2 (SGLT2) inhibitors such as empagliflozin have demonstrated possible hepatoprotective effects in previous research. The purpose of this study was to evaluate changes in liver enzymes, hepatic steatosis, and liver stiffness following 12 weeks of empagliflozin treatment in patients with T2DM and MASLD. METHODS: In this nonrandomized, single-arm interventional study, 30 patients with T2DM and MASLD were treated simultaneously with empagliflozin 25 mg/day for 12 weeks in addition to the ongoing management. Liver function tests (ALT and AST), hepatic fat content (CAP score), and liver stiffness (LSM) were assessed at baseline and after 12 weeks treatment. RESULTS: There were significant decreases in mean AST (80.27 ± 10.51 vs. 45.20 ± 3.20 U/L, P < 0.001) and ALT (86.33 ± 9.11 vs. 44.63 ± 3.62 U/L, P < 0.001) levels after treatment. The CAP score decreased from 321.83 ± 49.36 to 261.33 ± 35.14 (P < 0.001), and the LSM value decreased from 7.22 ± 1.04 to 6.24 ± 0.41 (P < 0.001). CONCLUSION: In this single-arm pre-post study, 12 weeks of empagliflozin treatment was associated with significant reductions in liver enzyme levels, hepatic steatosis, and liver stiffness in patients with T2DM and MASLD. Larger controlled studies are required to determine whether these changes are attributable to empagliflozin and to assess their durability.