Long-term metformin use may improve clinical outcomes in diabetic patients with non-alcoholic steatohepatitis and bridging fibrosis or compensated cirrhosis
Abstract
BACKGROUND: Metformin may protect against hepatocellular carcinoma and mortality among patients with type 2 diabetes. AIM: To investigate whether long-term use of metformin improves survival and reduces liver-related outcomes among patients with type 2 diabetes and non-alcoholic steatohepatitis. METHODS: A total of 191 diabetic patients with biopsy-proven non-alcoholic steatohepatitis and bridging fibrosis or compensated cirrhosis were retrospectively identified at Indiana University Medical Center between October 2004 and January 2016. Of them, 110 were users and 81 never-users of metformin. Primary outcomes were transplant-free survival, development of hepatocellular carcinoma or a first event of hepatic decompensation. RESULTS: Cirrhosis was present in 85% of metformin users and 88% of nonusers. Metformin dose was greater than or equal to 1 g/d in 104 out of 110 users and its median duration of use was 6 (95% CI: 4.4-7.9) years. The mean follow-up was 6.92 and 6.80 years for metformin users and non-users, respectively. During follow-up, 28 patients developed hepatocellular carcinoma (metformin users: 7, nonusers: 21), and 52 died (metformin users: 7, nonusers: 24) or were transplanted (metformin users: 13, non-users: 13). Metformin use was associated with lower risk of overall mortality or transplant (HR: 0.42; 95% CI: 0.24-0.74, P = 0.003) and hepatocellular carcinoma (sHR: 0.25; 95% CI: 0.11-0.58, P = 0.001), and remained independently associated with both outcomes after propensity-score and covariate-adjusted analyses. No instances of hepatotoxicity or lactic acidosis were observed. CONCLUSION: Our study demonstrated an association between long-term metformin use and reduced the risk of all-cause mortality/transplant and hepatocellular carcinoma in diabetics with non-alcoholic steatohepatitis and advanced fibrosis.
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Observational and case-control studies indicate that, in people with T2D and MASLD-related advanced fibrosis or cirrhosis, metformin may improve transplant-free survival (but not the risk of hepatic decompensation), and reduce the risk of primary liver and extrahepatic cancer.
“As far as clinical outcomes, there is some indication from observational and case-control studies that, in people with T2D and MASLD-related advanced fi brosis or cirrhosis, metformin may improve transplant-free survival (but not the risk of hepatic decompensation), and reduce the risk of primary liver and extrahepatic cancer.”
From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [430]
Cites
A Proportional Hazards Model for the Subdistribution of a Competing Risk
Fine, J. P., & Gray, R. J. (1999) · Journal of the American Statistical Association · doi:10.1080/01621459.1999.10474144 · Cited by 14,290 · see citing works
Design and validation of a histological scoring system for nonalcoholic fatty liver disease†
Kleiner, D. E., Brunt, E. M., Van Natta, M., Behling, C., Contos, M. J., Cummings, O. W., Ferrell, L. D., Liu, Y., Torbenson, M. S., Unalp‐Arida, A., et al. (2005) · Hepatology · doi:10.1002/hep.20701 · Cited by 10,791 · see citing works
Management of Hepatocellular Carcinoma: An Update Δσ
Bruix, J., & Sherman, M. (2011) · Hepatology · doi:10.1002/hep.24199 · Cited by 8,068 · see citing works
Chalasani, N., Younossi, Z., Lavine, J. E., Charlton, M., Cusi, K., Rinella, M., Harrison, S. A., Brunt, E. M., & Sanyal, A. J. (2018) · Hepatology · doi:10.1002/hep.29367 · Cited by 7,239 · see citing works
Global burden of NAFLD and NASH: trends, predictions, risk factors and prevention
Younossi, Z., Anstee, Q. M., Marietti, M., Hardy, T., Henry, L., Eslam, M., George, J., & Bugianesi, E. (2018) · Nature Reviews Gastroenterology & Hepatology · doi:10.1038/nrgastro.2017.109 · Cited by 5,249 · see citing works
Prognosis of Hepatocellular Carcinoma: The BCLC Staging Classification
Llovet, J., Brú, C., & Bruix, J. (1999) · Seminars in Liver Disease · doi:10.1055/s-2007-1007122 · Cited by 3,805 · see citing works
Byrne, C. D., & Targher, G. (2015) · Journal of Hepatology · doi:10.1016/j.jhep.2014.12.012 · Cited by 3,082 · see citing works
Vernon, G. C., Baranova, A. V., & Younossi, Z. M. (2011) · Alimentary Pharmacology & Therapeutics · doi:10.1111/j.1365-2036.2011.04724.x · Cited by 3,067 · see citing works
Vilar-Gomez, E., Martinez-Perez, Y., Calzadilla-Bertot, L., Torres-Gonzalez, A., Gra-Oramas, B., Gonzalez-Fabian, L., Friedman, S. L., Diago, M., & Romero-Gomez, M. (2015) · Gastroenterology · doi:10.1053/j.gastro.2015.04.005 · Cited by 2,492 · see citing works
Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis
García–Tsao, G., Sanyal, A. J., Grace, N. D., & Carey, W. (2007) · Hepatology · doi:10.1002/hep.21907 · Cited by 1,714 · see citing works
Lavine, J. E. (2011) · JAMA · doi:10.1001/jama.2011.520 · Cited by 1,105 · see citing works
Tilg, H., Moschen, A. R., & Roden, M. (2017) · Nature Reviews Gastroenterology & Hepatology · doi:10.1038/nrgastro.2016.147 · Cited by 1,002 · see citing works
Dysregulation of the TSC-mTOR pathway in human disease
Inoki, K., Corradetti, M. N., & Guan, K. (2004) · Nature Genetics · doi:10.1038/ng1494 · Cited by 970 · see citing works
Vilar-Gomez, E., Calzadilla-Bertot, L., Wai-Sun Wong, V., Castellanos, M., Aller-de la Fuente, R., Metwally, M., Eslam, M., Gonzalez-Fabian, L., Alvarez-Quiñones Sanz, M., Conde-Martin, A. F., et al. (2018) · Gastroenterology · doi:10.1053/j.gastro.2018.04.034 · Cited by 806 · see citing works
Risk of hepatocellular cancer in patients with non-alcoholic fatty liver disease
Kanwal, F., Kramer, J. R., Mapakshi, S., Natarajan, Y., Chayanupatkul, M., Richardson, P. A., Li, L., Desiderio, R., Thrift, A. P., Asch, S. M., et al. (2018) · Gastroenterology · doi:10.1053/j.gastro.2018.08.024 · Cited by 795 · see citing works
Bugianesi, E., Gentilcore, E., Manini, R., Natale, S., Vanni, E., Villanova, N., David, E., Rizzetto, M., & Marchesini, G. (2005) · The American Journal of Gastroenterology · doi:10.1111/j.1572-0241.2005.41583.x · Cited by 683 · see citing works
Gandini, S., Puntoni, M., Heckman-Stoddard, B. M., Dunn, B. K., Ford, L., DeCensi, A., & Szabo, E. (2014) · Cancer Prevention Research · doi:10.1158/1940-6207.capr-13-0424 · Cited by 457 · see citing works
Metformin as an adjuvant treatment for cancer: a systematic review and meta-analysis
Coyle, C., Cafferty, F. H., Vale, C. L., & Langley, R. E. (2016) · Annals of Oncology · doi:10.1093/annonc/mdw410 · Cited by 453 · see citing works
Griffin, S. J., Leaver, J. K., & Irving, G. J. (2017) · Diabetologia · doi:10.1007/s00125-017-4337-9 · Cited by 398 · see citing works
Chen, H.-P., Shieh, J., Chang, C., Chen, T.-T., Lin, J., Wu, M., Lin, J.-H., & Wu, C. (2012) · Gut · doi:10.1136/gutjnl-2011-301708 · Cited by 392 · see citing works
Metformin reduces endogenous reactive oxygen species and associated DNA damage
Algire, C., Moiseeva, O., Deschênes-Simard, X., Amrein, L., Petruccelli, L., Birman, E., Viollet, B., Ferbeyre, G., & Pollak, M. N. (2012) · Cancer Prevention Research · doi:10.1158/1940-6207.capr-11-0536 · Cited by 372 · see citing works
Bannister, C. A., Holden, S. E., Jenkins‐Jones, S., Morgan, C. L., Halcox, J. P., Schernthaner, G., Mukherjee, J., & Currie, C. J. (2014) · Diabetes, Obesity and Metabolism · doi:10.1111/dom.12354 · Cited by 356 · see citing works
Stine, J. G., Wentworth, B. J., Zimmet, A., Rinella, M. E., Loomba, R., Caldwell, S. H., & Argo, C. K. (2018) · Alimentary Pharmacology & Therapeutics · doi:10.1111/apt.14937 · Cited by 336 · see citing works
Singh, S., Singh, P. P., Singh, A. G., Murad, M. H., & Sánchez, W. (2013) · The American Journal of Gastroenterology · doi:10.1038/ajg.2013.5 · Cited by 318 · see citing works
Clinical trial: pilot study of metformin for the treatment of non-alcoholic steatohepatitis
LOOMBA, R., LUTCHMAN, G., KLEINER, D. E., RICKS, M., FELD, J. J., BORG, B. B., MODI, A., NAGABHYRU, P., SUMNER, A. E., LIANG, T. J., et al. (2009) · Alimentary Pharmacology & Therapeutics · doi:10.1111/j.1365-2036.2008.03869.x · Cited by 299 · see citing works
Crowley, M. J., Diamantidis, C. J., McDuffie, J. R., Cameron, C. B., Stanifer, J. W., Mock, C. K., Wang, X., Tang, S., Nagi, A., Kosinski, A. S., et al. (2017) · Annals of Internal Medicine · doi:10.7326/m16-1901 · Cited by 287 · see citing works
Metformin Use and All-Cause and Prostate Cancer–Specific Mortality Among Men With Diabetes
Margel, D., Urbach, D. R., Lipscombe, L. L., Bell, C. M., Kulkarni, G. S., Austin, P. C., & Fleshner, N. E. (2013) · Journal of Clinical Oncology · doi:10.1200/jco.2012.46.7043 · Cited by 271 · see citing works
Zheng, L., Yang, W. K., Wu, F., Wang, C., Yu, L., Tang, L., Qiu, B., Li, Y., Guo, L., Wu, M.-C., et al. (2013) · Clinical Cancer Research · doi:10.1158/1078-0432.ccr-13-0203 · Cited by 218 · see citing works
Zhang, X., Harmsen, W. S., Mettler, T. A., Kim, W. R., Roberts, R. O., Therneau, T. M., Roberts, L. R., & Chaiteerakij, R. (2014) · Hepatology · doi:10.1002/hep.27199 · Cited by 181 · see citing works
Impact of Metformin on the Prognosis of Cirrhosis Induced by Viral Hepatitis C in Diabetic Patients
Nkontchou, G., Cosson, E., Aout, M., Mahmoudi, A., Bourcier, V., Charif, I., Ganne‐Carrié, N., Grando–Lemaire, V., Vicaut, É., Trinchet, J., et al. (2011) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2010-2415 · Cited by 165 · see citing works
Sonnenblick, A., Agbor‐Tarh, D., Bradbury, I., Cosimo, S. D., Azim, H. A., Fumagalli, D., Sarp, S., Wolff, A. C., Andersson, M., Kroep, J. R., et al. (2017) · Journal of Clinical Oncology · doi:10.1200/jco.2016.69.7722 · Cited by 160 · see citing works
Metformin selectively targets redox control of complex I energy transduction
Cameron, A., Logie, L., Patel, K. A., Erhardt, S., Bacon, S., Middleton, P. K., Harthill, J. E., Forteath, C., Coats, J. T., Kerr, C., et al. (2017) · Redox Biology · doi:10.1016/j.redox.2017.08.018 · Cited by 153 · see citing works
Metformin and risk of hepatocellular carcinoma in patients with type 2 diabetes
Tseng, C. (2018) · Liver International · doi:10.1111/liv.13872 · Cited by 132 · see citing works
Meta-analysis of studies using metformin as a reducer for liver cancer risk in diabetic patients
Ma, S., Zheng, Y., Xiao, Y., Zhou, P., & Tan, H. (2017) · Medicine · doi:10.1097/md.0000000000006888 · Cited by 89 · see citing works
Therapeutic Trials in Nonalcoholic Steatohepatitis
Ratziu, V., Caldwell, S. H., & Neuschwander‐Tetri, B. A. (2010) · Hepatology · doi:10.1002/hep.24042 · Cited by 76 · see citing works
Metformin Inhibits Glutaminase Activity and Protects against Hepatic Encephalopathy
Ampuero, J., Ranchal, I., Nuñez, D., Díaz-Herrero, M. D. M., Maraver, M., Campo, J. A. D., Rojas, Á., Camacho, I., Figueruela, B., Bautista, J., et al. (2012) · PLoS ONE · doi:10.1371/journal.pone.0049279 · Cited by 68 · see citing works
Prognosis of small cell lung cancer patients with diabetes treated with metformin
Xu, T., Liang, G., Yang, L., & Zhang, F. (2015) · Clinical & Translational Oncology · doi:10.1007/s12094-015-1311-1 · Cited by 30 · see citing works
Emerging Treatments for Nonalcoholic Fatty Liver Disease and Nonalcoholic Steatohepatitis
Gawrieh, S., & Chalasani, N. (2017) · Clinics in Liver Disease · doi:10.1016/j.cld.2017.08.013 · Cited by 29 · see citing works
Prognostic value of metformin for non-small cell lung cancer patients with diabetes
Xu, T., Li, D., He, Y., Zhang, F.-L., Qiao, M., & Chen, Y. (2018) · World Journal of Surgical Oncology · doi:10.1186/s12957-018-1362-1 · Cited by 25 · see citing works
Vilar‐Gómez, E., Vuppalanchi, R., Gawrieh, S., Ghabril, M., Saxena, R., Cummings, O. W., & Chalasani, N. (2018) · Author eBooks · Cited by 4 · see citing works
Miller, E., Dakhoul, L., Sbeih, H. A., Mao, E., deLemos, A. S., Roche, P., Scanga, A. E., Vilar‐Gómez, E., Gawrieh, S., Chalasani, N., et al. (2018) · Journal of Hepatology · doi:10.1016/s0168-8278(18)31917-2 · Cited by 2 · see citing works
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Tacke, F., Horn, P., Wai-Sun Wong, V., Ratziu, V., Bugianesi, E., Francque, S., Zelber-Sagi, S., Valenti, L., Roden, M., Schick, F., et al. (2024) · Journal of Hepatology · doi:10.1016/j.jhep.2024.04.031 · Cited by 2,210 · see citing works
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Current treatment of non‐alcoholic fatty liver disease
Paternostro, R., & Trauner, M. (2022) · Journal of Internal Medicine · doi:10.1111/joim.13531 · Cited by 305 · see citing works
Therapeutic pipeline in nonalcoholic steatohepatitis
Vuppalanchi, R., Noureddin, M., Alkhouri, N., & Sanyal, A. J. (2021) · Nature Reviews Gastroenterology & Hepatology · doi:10.1038/s41575-020-00408-y · Cited by 278 · see citing works
KASL clinical practice guidelines: Management of nonalcoholic fatty liver disease
Kang, S. H., Lee, H. W., Yoo, J., Cho, Y., Kim, S. U., Lee, T. H., Jang, B. K., Ahn, S. B., Ahn, S. B., Kim, H., et al. (2021) · Clinical and Molecular Hepatology · doi:10.3350/cmh.2021.0178 · Cited by 269 · see citing works
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Mantovani, A., & Dalbeni, A. (2021) · International Journal of Molecular Sciences · doi:10.3390/ijms22052350 · Cited by 202 · see citing works
Prevention of NAFLD-associated HCC: Role of lifestyle and chemoprevention
Lange, N. F., Radu, P., & Dufour, J. (2021) · Journal of Hepatology · doi:10.1016/j.jhep.2021.07.025 · Cited by 137 · see citing works
Nonalcoholic fatty liver disease and type 2 diabetes: where do Diabetologists stand?
Tomah, S., Alkhouri, N., & Hamdy, O. (2020) · Clinical Diabetes and Endocrinology · doi:10.1186/s40842-020-00097-1 · Cited by 117 · see citing works
Qi, X., Li, J., Caussy, C., Teng, G., & Loomba, R. (2024) · Hepatology · doi:10.1097/hep.0000000000000913 · Cited by 109 · see citing works
Xian, Y., Weng, J., & Xu, F. L. (2020) · Chinese Medical Journal · doi:10.1097/cm9.0000000000001263 · Cited by 106 · see citing works
Duseja, A. K., Singh, S. P., De, A., Madan, K., Rao, P. N., Shukla, A., Choudhuri, G., Saigal, S., Shalimar, S., Arora, A., et al. (2022) · Journal of Clinical and Experimental Hepatology · doi:10.1016/j.jceh.2022.11.014 · Cited by 105 · see citing works
Roeb, E., Canbay, A. E., Tacke, F., Bantel, H., Bojunga, J., de Laffolie, J., Demir, M., Denzer, U. W., Geier, A., Hofmann, W. P., et al. (2022) · Zeitschrift für Gastroenterologie · doi:10.1055/a-1880-2283 · Cited by 102 · see citing works
Diabetes medications and risk of HCC
Plaz Torres, M. C., Jaffe, A., Perry, R., Marabotto, E., Strazzabosco, M., & Giannini, E. G. (2022) · Hepatology · doi:10.1002/hep.32439 · Cited by 86 · see citing works
Vilar‐Gómez, E., Bertot, L. C., Wong, V. W., Castellanos, M., la Fuente, R. A., Eslam, M., Wong, G. L., George, J., Romero‐Gómez, M., & Adams, L. A. (2020) · Clinical Gastroenterology and Hepatology · doi:10.1016/j.cgh.2020.04.083 · Cited by 85 · see citing works
Diabetes and cirrhosis: Current concepts on diagnosis and management
Castéra, L., & Cusi, K. J. (2023) · Hepatology · doi:10.1097/hep.0000000000000263 · Cited by 87 · see citing works
Yang, K., & Song, M. J. (2023) · Nutrients · doi:10.3390/nu15183970 · Cited by 72 · see citing works
Lipotoxicity as the Leading Cause of Non-Alcoholic Steatohepatitis
Branković, M., Jovanović, I., Dukić, M., Radonjić, T., Oprić, S., Klašnja, S., & Zdravkovic, M. D. (2022) · International Journal of Molecular Sciences · doi:10.3390/ijms23095146 · Cited by 67 · see citing works
Perspectives on the Underlying Etiology of HCC and Its Effects on Treatment Outcomes
Ito, T., & Nguyen, M. H. (2023) · Journal of Hepatocellular Carcinoma · doi:10.2147/jhc.s347959 · Cited by 61 · see citing works
Zhang, Y., Wang, H.-B., & Xiao, H. (2021) · International Journal of Molecular Sciences · doi:10.3390/ijms22095016 · Cited by 51 · see citing works
Kaplan, D. E., Serper, M., John, B. V., Tessiatore, K. M., Lerer, R., Mehta, R. L., Fox, R. K., Aytaman, A., Baytarian, M. L., Hunt, K. K., et al. (2020) · Clinical Gastroenterology and Hepatology · doi:10.1016/j.cgh.2020.08.026 · Cited by 55 · see citing works
Management of diabetes mellitus in patients with cirrhosis: An overview and joint statement
Boursier, J., Anty, R., Carette, C., Cariou, B., Castéra, L., Caussy, C., Fontaine, H., Garioud, A., Gourdy, P., Guerci, B., et al. (2021) · Diabetes & Metabolism · doi:10.1016/j.diabet.2021.101272 · Cited by 49 · see citing works
García‐Compeán, D., Orsi, E., Kumar, R. K., Gundling, F., Nishida, T., Villarreal‐Pérez, J. Z., del Cueto-Aguilera, Á. N., González, J. A., & Pugliese, G. (2022) · World Journal of Gastroenterology · doi:10.3748/wjg.v28.i8.775 · Cited by 47 · see citing works
Sohn, W., Lee, Y., Kim, S. S., Kim, J. H., Jin, Y., Kim, G., Sung, P. S., Yoo, J., Chang, Y. W., Lee, E. J., et al. (2025) · Clinical and Molecular Hepatology · doi:10.3350/cmh.2025.0045 · Cited by 53 · see citing works
Armandi, A., Rosso, C., Caviglia, G. P., & Bugianesi, E. (2024) · Metabolism · doi:10.1016/j.metabol.2024.156080 · Cited by 43 · see citing works
Ruissen, M. M., Mak, A. L., Beuers, U. H., Tushuizen, M. E., & Holleboom, A. G. (2020) · European Journal of Endocrinology · doi:10.1530/eje-20-0065 · Cited by 43 · see citing works
Impact of metformin use on risk and mortality of hepatocellular carcinoma in diabetes mellitus
Li, Q., Xu, H., Sui, C., & Zhang, H. (2021) · Clinics and Research in Hepatology and Gastroenterology · doi:10.1016/j.clinre.2021.101781 · Cited by 40 · see citing works
Zisis, M., Chondrogianni, M. E., Ανδρουτσάκος, Θ., Rantos, I., Oikonomou, E. K., Chatzigeorgiou, A., & Kassi, E. N. (2025) · Biomolecules · doi:10.3390/biom15030324 · Cited by 42 · see citing works
Bertot, L. C., Vilar‐Gómez, E., Wong, V. W., Romero‐Gómez, M., la Fuente, R. A., Wong, G. L., Castellanos, M., Eslam, M., Desai, A. P., Jeffrey, G. P., et al. (2020) · Hepatology · doi:10.1002/hep.31576 · Cited by 39 · see citing works
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Key takeaways from the updated multidisciplinary European MASLD guidelines
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The role of anti-diabetic drugs in NAFLD. Have we found the Holy Grail? A narrative review
Zachou, M., Flevari, P., Ansari, N. N., Varytimiadis, C., Kalaitzakis, E., Kassi, E. N., & Ανδρουτσάκος, Θ. (2023) · European Journal of Clinical Pharmacology · doi:10.1007/s00228-023-03586-1 · Cited by 36 · see citing works
Arvanitakis, K., Koufakis, T., Kalopitas, G., Papadakos, S. P., Kotsa, K., & Germanidis, G. S. (2023) · Diabetes & Metabolic Syndrome Clinical Research & Reviews · doi:10.1016/j.dsx.2023.102935 · Cited by 32 · see citing works
Metformin use and cirrhotic decompensation in patients with type 2 diabetes and liver cirrhosis
Yen, F., Huang, Y., Hou, M., Hwu, C., Lo, Y., Shin, S., & Hsu, C. (2021) · British Journal of Clinical Pharmacology · doi:10.1111/bcp.14970 · Cited by 24 · see citing works
An Approach to the Management of Diabetes Mellitus in Cirrhosis: A Primer for the Hepatologist
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Present and Future Perspectives in the Treatment of Liver Fibrosis
Cerrito, L., Galasso, L., Iaccarino, J., Pizzi, A., Termite, F., Esposto, G., Borriello, R., Ainora, M. E., Gasbarrini, A., & Zocco, M. A. (2025) · Pharmaceuticals · doi:10.3390/ph18091321 · Cited by 27 · see citing works
Anti-diabetic drugs and NASH: from current options to promising perspectives
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Yen, F., Hsu, C., Wei, J. C., Hou, M., & Hwu, C. (2022) · Frontiers in Medicine · doi:10.3389/fmed.2022.839456 · Cited by 21 · see citing works
Cheraghpour, M., Hatami, B., & Singal, A. G. (2025) · Clinical Gastroenterology and Hepatology · doi:10.1016/j.cgh.2024.09.041 · Cited by 19 · see citing works
Therapeutic Targets and Approaches to Manage Inflammation of NAFLD
Geng, W., Liao, W., Cao, X., & Yang, Y. (2025) · Biomedicines · doi:10.3390/biomedicines13020393 · Cited by 20 · see citing works
Lee, H. W., Lee, J. S., Kim, B. K., Park, J. Y., Kim, D. Y., Ahn, S. H., & Kim, S. U. (2020) · Journal of Diabetes and its Complications · doi:10.1016/j.jdiacomp.2020.107747 · Cited by 18 · see citing works
Redman, J. S., Kaspar, M., & Puri, P. (2021) · Translational Gastroenterology and Hepatology · doi:10.21037/tgh-20-236 · Cited by 12 · see citing works
Yip, T. C., Chan, R. N. C., Wong, V. W., Tse, Y., Liang, L. Y., Hui, V. W., Zhang, X., Li, G., Chan, H. L., & Wong, G. L. (2021) · Health Science Reports · doi:10.1002/hsr2.352 · Cited by 9 · see citing works
Malandris, K., Charalampidis, K., Loomba, R. S., & Sinakos, E. (2026) · Current Diabetes Reports · doi:10.1007/s11892-026-01621-w · Cited by 9 · see citing works
Saiman, Y., Hooks, R., & Carr, R. M. (2020) · Current Hepatology Reports · doi:10.1007/s11901-020-00539-5 · Cited by 8 · see citing works
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Peppas, S., Doumas, S., Suvarnakar, A. M., Chou, J., Arafat, A., Ahmad, A. I., & Lewis, J. H. (2024) · European Journal of Gastroenterology & Hepatology · doi:10.1097/meg.0000000000002754 · Cited by 8 · see citing works
Holleboom, A. G., Francque, S., Cusi, K. J., & Caussy, C. (2025) · Metabolism Open · doi:10.1016/j.metop.2025.100424 · Cited by 8 · see citing works
Fassio, E., Colombato, L., Gualano, G., Perez, S., Puga‐Tejada, M., & Landeira, G. (2025) · Cancers · doi:10.3390/cancers17061018 · Cited by 5 · see citing works
Chemoprevention of hepatocellular carcinoma
Schwenk, S., & Kaplan, D. E. (2025) · Hepatology Communications · doi:10.1097/hc9.0000000000000836 · Cited by 5 · see citing works
Misceo, D., Mocciaro, G., D’Amore, S., & Vacca, M. (2024) · Nutrition & Metabolism · doi:10.1186/s12986-024-00871-3 · Cited by 6 · see citing works
Vilar‐Gómez, E., & Chalasani, N. (2019) · Clinical Gastroenterology and Hepatology · doi:10.1016/j.cgh.2019.06.032 · Cited by 5 · see citing works
Pieralice, S., Amendolara, R., Berna, V., Manganaro, G., Zurru, A., D’Onofrio, L., Risi, R., Alfonsi, M., Maddaloni, E., & Buzzetti, R. (2025) · Diabetes Metabolic Syndrome and Obesity · doi:10.2147/dmso.s528569 · Cited by 6 · see citing works
Zhang, X., Yip, T. C., Tse, Y., Hui, V. W., Li, G., Lin, H., Liang, L. Y., Lai, J. C., Lai, M. S., Cheung, J. T. K., et al. (2023) · Alimentary Pharmacology & Therapeutics · doi:10.1111/apt.17428 · Cited by 4 · see citing works
Scheen, A. J. (2023) · Expert Opinion on Drug Metabolism & Toxicology · doi:10.1080/17425255.2023.2252333 · Cited by 4 · see citing works
Liver Fibrosis: Molecular Pathogenesis and Therapeutic Interventions
Qu, J.-R., Qin, W., Dong, M.-H., Ma, Z., Li, S., Liu, R.-P., Chen, R.-Y., Li, C., & Li, X. (2026) · MedComm · doi:10.1002/mco2.70750 · Cited by 4 · see citing works
Shojaeian, A., Nakhaie, M., Amjad, Z. S., Boroujeni, A. K., Shokri, S., & Mahmoudvand, S. (2024) · Journal of Cancer Metastasis and Treatment · doi:10.20517/2394-4722.2023.147 · Cited by 3 · see citing works
Wang, M. Y., Song, S. J., Peng, N., Wong, G. L., Wong, V. W., Lai, J. C., & Yip, T. C. (2026) · Alimentary Pharmacology & Therapeutics · doi:10.1111/apt.70705 · Cited by 2 · see citing works
Arab, J. P., Castro, L., GOMEZ, P. C., Vignolo, P., Arrese, M. A., Francisco Barrera, M., Castro, F., Díaz, L. A., Donoso, A., Elgueta, K., et al. (2021) · Revista médica de Chile · doi:10.4067/s0034-98872021000901360 · Cited by 2 · see citing works
Nonalcoholic Fatty Liver Disease and Obesity
De, A., & Duseja, A. K. (2021) · Journal of Postgraduate Medicine Education and Research · doi:10.5005/jp-journals-10028-1430 · Cited by 2 · see citing works
Bando, H. (2021) · Edelweiss Journal of Biomedical Research and Review · doi:10.33805/2690-2613.118 · Cited by 2 · see citing works
Letter: metformin treatment and hepatocellular carcinoma risk in non‐alcoholic fatty liver disease
Doğru, T., Kırık, A., & Sönmez, A. (2019) · Alimentary Pharmacology & Therapeutics · doi:10.1111/apt.15462 · Cited by 2 · see citing works
Der hepatogene Diabetes – aktueller Stand der Diagnostik und Therapie
Gundling, F. (2022) · Journal für Klinische Endokrinologie und Stoffwechsel · doi:10.1007/s41969-022-00158-z · Cited by 1 · see citing works
Diagnose und Therapie der MASLD
Horn, P., & Tacke, F. (2025) · Die Innere Medizin · doi:10.1007/s00108-025-01896-3 · Cited by 1 · see citing works
Future research direction of portal hypertension based on Baveno VII
Luo, X., Wang, G., Yang, L., & Hernández–Gea, V. (2025) · Chinese Medical Journal · doi:10.1097/cm9.0000000000003785 · Cited by 1 · see citing works
Metabolic Dysfunction-Associated Steatotic Liver Disease
De, A., & Duseja, A. K. (2026) · Springer eBooks · doi:10.1007/978-981-95-2624-6_13 · Cited by 1 · see citing works
Metabolische Lebererkrankungen bei Adipositas
Horn, P., & Tacke, F. (2026) · Adipositas - Ursachen Folgeerkrankungen Therapie · doi:10.1055/a-2722-1114 · Cited by 1 · see citing works
Zhang, Y., & Xu, C. (2024) · Journal of Biosciences and Medicines · doi:10.4236/jbm.2024.1211015 · Cited by 1 · see citing works
Ratziu, V., & Pais, R. (2019) · Alimentary Pharmacology & Therapeutics · doi:10.1111/apt.15414 · Cited by 1 · see citing works
Letter: metformin reduces the risk of hepatocellular carcinoma in diabetic patients
Huo, R., Liang, J., He, F., Xu, B., Ma, L., & Yuan, W. (2019) · Alimentary Pharmacology & Therapeutics · doi:10.1111/apt.15467 · Cited by 1 · see citing works
Diabetes and Non‐alcoholic Fatty Liver Disease
Mantovani, A., Targher, G., & Byrne, C. D. (2024) · Wiley eBooks · doi:10.1002/9781119697473.ch57 · Cited by 1 · see citing works
Ianiro, G., Ponziani, F. R., Gasbarrini, A., & Cammarota, G. (2019) · Alimentary Pharmacology & Therapeutics · doi:10.1111/apt.15391
Vilar‐Gómez, E., & Chalasani, N. (2019) · Alimentary Pharmacology & Therapeutics · doi:10.1111/apt.15488
Letter: metformin reduces the risk of hepatocellular carcinoma in diabetic patients. Authors' reply
Vilar‐Gómez, E., & Chalasani, N. (2019) · Alimentary Pharmacology & Therapeutics · doi:10.1111/apt.15486
Pharmacological Options for NASH
Stern, C., & Ratziu, V. (2020) · Springer eBooks · doi:10.1007/978-3-319-95828-6_17
Ruolo dei farmaci antidiabete nel trattamento della NAFLD
Mantovani, A. (2021) · il Diabete · doi:10.30682/ildia2102b
Metabolic-associated fatty liver disease: pharmacological management
Shi, Y., & Fan, J. (2023) · Elsevier eBooks · doi:10.1016/b978-0-323-98368-6.00010-0
Papel de la metformina en los tiempos del paciente cardiorrenometabólico
Arranz-Martínez, E., Hernández-Teixidó, C., & García, A. R. (2025) · Medicina de Familia SEMERGEN · doi:10.1016/j.semerg.2025.102530
Kouti, T., Christodoulou, P., Christodoulides, S., Protopapa, F., Michaeloudes, C., & Farazi, P. A. (2026) · Frontiers in Nutrition · doi:10.3389/fnut.2026.1767917
Metabolische Lebererkrankungen bei Adipositas
Horn, P., & Tacke, F. (2026) · Aktuelle Ernährungsmedizin · doi:10.1055/a-2807-4330
Passos, P. R. C., Motta, R. V., Filho, V. O. C., Noronha, M. M., Venâncio, R. C., Cançado, G. G. L., Adler, A., Cobbold, J. F., & Tomlinson, J. (2026) · Diabetes Care · doi:10.2337/dc26-0336
Horn, P., & Tacke, F. (2026) · Die Diabetologie · doi:10.1007/s11428-026-01498-z
Management of cirrhosis in diabetes: a pragmatic approach to the patient
Kumar, A., & Basu, R. (2026) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgag321
- Authors
- Vilar‐Gomez, E., Vuppalanchi, R., Desai, A. P., Gawrieh, S., Ghabril, M., Saxena, R., Cummings, O. W., & Chalasani, N.
- Affiliations
- Division of Gastroenterology and Hepatology Indiana University School of Medicine Indianapolis Indiana
- Indiana University Indianapolis (US)
- Indiana University School of Medicine (US)
- Corresponding author
- Chalasani, Naga
- ORCID
- Venue
- Alimentary Pharmacology & Therapeutics
- Publisher
- Wiley
- Published
- 2019-06-03
- Volume
- 50
- Issue
- 3
- Pages
- 317-328
- ISSN
- 0269-2813 (ISSN-L)
- 1365-2036
- OpenAlex
- W2948364100
- Cited by
- 84
- References
- 41
- Citations by year
- 2026: 11 · 2025: 13 · 2024: 9 · 2023: 8 · 2022: 10 · 2021: 16 · 2020: 10 · 2019: 7
- FWCI
- 8.18
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Alimentary Pharmacology & Therapeutics (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Epidemiology › Liver Disease Diagnosis and Treatment
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Metabolism, Diabetes, and Cancer
- Health Sciences › Medicine › Hepatology › Hepatocellular Carcinoma Treatment and Prognosis
- Keywords
- metformin, nonalcoholic steatohepatitis, type 2 diabetes, compensated cirrhosis, bridging fibrosis, hepatocellular carcinoma, transplant-free survival, all-cause mortality, hepatic decompensation, liver fibrosis
- MeSH terms
- Aged, Diabetes Mellitus, Type 2, Female, Follow-Up Studies, Carcinoma, Hepatocellular, Humans, Liver Cirrhosis, Liver Neoplasms, Male, Metformin, Middle Aged, Prognosis, Retrospective Studies, Time Factors, Survival Analysis, Treatment Outcome, Non-alcoholic Fatty Liver Disease
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