Drug Treatment for Liver Disease

A drug traditionally used to treat diabetes could reverse the symptoms of nonalcoholic steatohepatitis — a type of liver disease. Recent research reveals pioglitazone (Actos) effectively reduces fats and inflammation in the liver.

Fifty-five patients with nonalcoholic steatohepatitis and impaired glucose tolerance or type 2 diabetes followed a liver treatment plan for six months. One group of patients followed a low calorie diet and pioglitazone treatment. The other group followed a low calorie diet and took placebo. After six months, both groups showed a reduction in liver inflammation, but those taking pioglitazone had reduced levels of fats in the liver and decreased insulin sensitivity.

“We had a reduction by half in fatty liver and inflammation,” Dr. Cusi said. “This was also associated with improvement in the way the body handles sugar and lipids.”

Nonalcoholic steatohepatitis is difficult to diagnose in the early stage, which means the liver may withstand a great deal of damage before the disease is detected. The disease can cause chronic liver cell death and scarring, or fibrosis. Liver fibrosis can lead to irreversible cirrhosis.

“We think up to one in four patients with NASH [nonalcoholic steatohepatitis] might end up with cirrhosis,” Dr. Cusi said. “Once you develop cirrhosis, half of them [patients] die within five to 10 years.”

A drug option that reverses deterioration of the liver and eventual cirrhosis could have a large impact on the quality of life and lifespan of those living with nonalcoholic steatohepatitis.

“We didn’t expect the improvement to be so impressive,” Dr. Cusi said. “I think the word of caution is this is the first step in the right direction, but much more work needs to be done to look at the long-term efficacy to confirm this in a larger group of patients.”

SOURCE: Ivanhoe interview with Kenneth Cusi, M.D., University of Texas Health Science Center; The New England Journal of Medicine, 2006;355:2297-2307