Pioglitazone (Actos) Helps Reverse Fatty liver in Diabetes

Fatty liver, or steatosis, is a term that describes the buildup of fat in the liver. Although it is normal to have some amount of fat in your liver, if it makes up more than 5%-10% of your liver weight, you may have fatty liver.

Fatty liver is caused by number of risk factors including alcohol, obesity, diabetes, genetic factors, etc.,

Fatty liver sometimes can cause serious liver damage

Approximately 10-20% of Americans have fatty liver but not all of them have inflammation of the liver due this excess fat accumulation. When there is inflammation, a condition called steatohepatitis, it may result in permanent scarring and may even lead to cirrhosis of the liver.

Commonly used diabetes medication may help fatty liver

A recent study published in Annals of Internal Medicine found that long-term use of pioglitazone (Actos) may reverse fatty liver in people with prediabetes and diabetes. The study was done in patients who drink minimal to no alcohol and has fatty liver, called non-alcoholic steatohepatitis (NASH).

The randomized double-blind, placebo-controlled trial included 101 patients with NASH- 49% had prediabetes and 51% had type 2 diabetes.

Patients were recruited between 2008 and 2014 from outpatient clinics and the general population in San Antonio, Texas, and tested at The University of Texas Health Science Center at San Antonio.

The patients were randomly assigned to daily pioglitazone 30-45 mg or placebo for 18 months followed by an 18-month open-label phase with pioglitazone treatment. They were also asked to follow a hypocaloric diet with a daily deficit of 500 kcal.

Overall, 51% patients who received pioglitazone for 3 years achieved NASH resolution compared to 19% in the placebo arm.

These encouraging results suggest that this drug may halt progression of fatty liver and alter the natural history of the disease in patients with diabetes.

Not easy to lose weight

Previous studies showed that weight loss will result in improvement in NASH. “Although weight loss of 5% or greater may improve NASH, most affected persons are unable to achieve or sustain this amount of weight loss. Thus, pharmacologic therapies targeting NASH would be welcome additions to the therapeutic toolbox,” write Eduardo Vilar-Gomez, MD, PhD, from the University of Seville, Spain, and Leon A. Adams, MBBS, PhD, from the University of Western Australia, in an accompanying editorial.