The diabetes medicine pioglitazone (brand name Actos) is effective in stopping the progression of nonalcoholic steatohepatitis (NASH), a liver disease caused by buildup of fat in the organ, in people with prediabetes and Type 2 diabetes. Approximately 80% of people with Type 2 have fat in the liver, and nearly one-third are estimated to have NASH.
Pioglitazone, a member of the thiazolidinedione class of medicines, was approved in the United States as Actos in 2000 and in generic form in 2012. This class of medicines, also known as glitzaones or TZDs, works by decreasing insulin resistance in muscle and fat cells and reducing glucose production in the liver.
NASH, which occurs in people who drink little to no alcohol, is often known as “silent” liver disease because people with the condition frequently have no symptoms. It is characterized by fat in the liver, along with liver inflammation and damage, and is the second leading cause of liver transplants in the United States. (Nonalcoholic fatty liver disease, or NAFLD, affects roughly 10% to 20% of Americans and is marked by fat in the liver without inflammation or damage.) Left untreated, NASH can lead to liver cancer or cirrhosis (a chronic liver disease in which liver tissue is replaced by scar tissue). People who have obesity and prediabetes or Type 2 diabetes are at greatest risk of developing the condition.
Currently, treatments for NASH focus on weight loss and improved diabetes control, but no medications have been available to treat the condition to date. To determine the effectiveness and safety of pioglitazone for this type of liver disease, researchers treated 101 people with prediabetes or Type 2 diabetes and NASH with either the medicine or placebo (inactive treatment) for three years. The participants were also asked to follow a low-calorie diet.
The researchers found that pioglitazone “reduced fatty liver disease activity” in 58% of the subjects and reduced the condition enough that it was no longer considered a threat to the liver in 51% of the participants (compared to 19% of those receiving placebo).
“The exciting thing is that there is a generic drug that already prevents the onset of Type 2 diabetes and cardiovascular disease in recent studies. Now, it can reduce disease from excess liver fat accumulation and liver inflammation, and halt fibrosis that leads to cirrhosis,” noted lead study author Kenneth Cusi, MD. “This will have a lot of long-term benefits for many people with a medication that will be very affordable and is already being used to treat Type 2 diabetes.”
Researchers haven’t determined exactly how pioglitazone acts against NASH, but they suspect the medicine may help make the liver and other tissues in the body become more sensitive to insulin, reducing the accumulation of fat and inflammation in the liver. To learn more about how the medicine works and its long-term benefits for the liver, scientists will need to further study pioglitazone in a large, years-long clinical trial.
For more information, read the article “Existing Diabetes Drug Shows Effectiveness Against Chronic Liver Disease” or see the study’s abstract in the journal Annals of Internal Medicine. And for more on symptoms, diagnosis, and treatment of fatty liver, see “Don’t Call My Liver Fat!” by certified diabetes educator and registered dietitian Amy Campbell.
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