Cited by 75Liver Disease Diagnosis and TreatmentDiabetes Treatment and ManagementDrug-Induced Hepatotoxicity and Protection

Licogliflozin for nonalcoholic steatohepatitis: a randomized, double-blind, placebo-controlled, phase 2a study

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Harrison, Stephen A., Manghi, Federico Perez, Smith, William B., Alpenidze, Diana, Aizenberg, Diego, Klarenbeek, Naomi, Chen, Chi-Yi, Zuckerman, Eli +17 more·2022·Nature Medicine

Abstract

Nonalcoholic steatohepatitis (NASH) is a common chronic liver disease that may advance to fibrosis and lead to mortality; however, no pharmacotherapy is currently available. We tested the hypothesis that inhibition of both the sodium–glucose cotransporters 1 and 2 with licogliflozin would lead to improvement in NASH. A total of 107 patients with phenotypic or histologic NASH were randomized (1:2:2) to receive oral administration of either placebo (n = 21), licogliflozin 30 mg (n = 43) or 150 mg (n = 43) once daily for 12 weeks. Licogliflozin 150 mg showed a significant 32% (80% confidence interval (CI): 21–43%; P = 0.002) placebo-adjusted reduction in serum alanine aminotransferase after 12 weeks of treatment, the primary endpoint of the study. However, the 30 mg dose of licogliflozin did not meet the primary endpoint (placebo-adjusted reduction 21% (80% CI: 7–32%; P = 0.061)). Diarrhea occurred in 77% (33 of 43), 49% (21 of 43) and 43% (9 of 21) of patients treated with licogliflozin 150 mg, 30 mg and placebo, respectively, which was mostly mild in severity. No other major safety concerns were identified. Treatment with 150 mg licogliflozin led to reductions in serum alanine aminotransferase in patients with NASH. Studies of longer duration and in combination with drugs that have different mechanisms of action are needed to validate these findings and to define a role of licogliflozin as a therapeutic option for NASH. ClinicalTrials.gov identifier: NCT03205150. In a phase 2a clinical trial in patients with nonalcoholic steatohepatitis, dual inhibition of sodium–glucose cotransporters 1 and 2 with 150 mg of licogliflozin led to reductions in serum alanine aminotranferase levels.

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  • In a small-scale pilot study, empagliflozin reduced steatosis, ballooning and fibrosis after 24 weeks in people with type 2 diabetes and MASH compared to pre-treatment and historical control.

    “In a small-scale pilot study, empagliflozin reduced steatosis, ballooning and fibrosis after 24 weeks of treatment in people with type 2 diabetes and MASH when compared to pre-treatment and a historical control group (BMI reduction of 0.7 kg/m 2 , total body weight not provided) [158].”

    From Obesity and MASLD: Is weight loss the (only) key to treat metabolic liver disease? (2024) · cites this paper as [158]

    The Abstract reports a 24-week empagliflozin study with reduced steatosis only in a subgroup, but says its participants had NAFLD without type 2 diabetes and were compared with placebo. The Discussion reports reduced liver stiffness, a surrogate for fibrosis; it does not report improvements in ballooning or a comparison with a historical control group. No page numbers are available in our copy. (LLM, conf=0.88)

    Experimental — accuracy not yet measured
  • Reductions in ALT were shown with empagliflozin and licogliflozin.

    “Reductions in ALT were shown with empagli fl ozin 414 and licogli fl ozin.”
  • Clinical evidence for SGLT2 inhibitors specifically as NASH treatment is currently limited.

    “However, clinical evidence on SGLT2 inhibitors as a treatment specifically for NASH is currently limited.126”

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Authors
Harrison, S. A., Manghi, F. P., Smith, W. B., Alpenidze, D., Aizenberg, D., Klarenbeek, N., Chen, C.-Y., Zuckerman, E., Ravussin, E., Charatcharoenwitthaya, P., Cheng, P.-N., Katchman, H., Klein, S., Ben-Ari, Z., Mendonza, A. E., Zhang, Y., Martic, M., Ma, S., Kao, S., Tanner, S., Pachori, A., Badman, M. K., He, Y., Ukomadu, C., & Sicard, E.
Affiliations
  • Pinnacle Clinical Research (US)
  • University of Tennessee Medical Center (US)
  • Centre for Human Drug Research (NL)
  • Chia-Yi Christian Hospital (TW)
  • Carmel Medical Center (IL)
  • Siriraj Hospital (TH)
  • National Cheng Kung University Hospital (TW)
  • Tel Aviv Sourasky Medical Center (IL)
  • Washington University in St. Louis (US)
  • Novartis Institutes for BioMedical Research (CH)
Corresponding author
Harrison, Stephen A.
Venue
Nature Medicine
Published
2022-06-20
Volume
28
Issue
7
Pages
1432-1438
ISSN
  • 1078-8956 (ISSN-L)
  • 1546-170X
OpenAlex
W4283159936
Cited by
75
References
32
Citations by year
2026: 10 · 2025: 26 · 2024: 17 · 2023: 19 · 2022: 3
FWCI
11.73
Type
journal article
Language
en
Open access
Locations
  • Nature Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • Civil War Book Review (submittedVersion)
Funders
Novartis Pharmaceuticals
Topics
  • Health Sciences › Medicine › Epidemiology › Liver Disease Diagnosis and Treatment
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
  • Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Pharmacology › Drug-Induced Hepatotoxicity and Protection
Keywords
nonalcoholic steatohepatitis, sodium-glucose cotransporter, alanine aminotransferase, liver fibrosis, pharmacotherapy, diarrhea, dose comparison
MeSH terms
Alanine Transaminase, Anhydrides, Double-Blind Method, Humans, Sorbitol, Treatment Outcome, Non-alcoholic Fatty Liver Disease

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