In a small study, pioglitazone was associated with several positive histologic and metabolic outcomes.
Nonalcoholic steatohepatitis (NASH) has been recognized increasingly as a cause of clinically important liver disease (Journal Watch Nov 7 2006). Because NASH is associated with insulin resistance, drugs that reduce insulin resistance have been proposed as treatments.
In a partially industry-supported trial from San Antonio, 55 patients with biopsy-confirmed NASH, and with either impaired glucose tolerance or type 2 diabetes, were randomized to receive pioglitazone (a thiazolidinedione that reduces insulin resistance) or placebo. Because patients were generally obese, they were also instructed about a weight-reduction diet. After 6 months of treatment, pioglitazone recipients had significant reductions in serum transaminase levels and hepatic fat content and significantly increased hepatic insulin sensitivity, compared with placebo recipients. In addition, liver biopsies after 6 months showed significant reductions in steatosis and inflammation in the pioglitazone group compared with the placebo group.
Comment: In this small study, pioglitazone therapy was associated with several favorable histologic and metabolic outcomes in patients with nonalcoholic steatohepatitis. However, studies of longer duration are necessary to determine whether drugs in this class will reduce morbidity and mortality in such patients.
— Allan S. Brett, MD
Published in Journal Watch General Medicine December 13, 2006
Citation(s):
Belfort R et al. A placebo-controlled trial of pioglitazone in subjects with nonalcoholic steatohepatitis. N Engl J Med 2006 Nov 30; 355:2297-307.