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Comparison of semaglutide in combined with empagliflozin versus semaglutide and empagliflozin monotherapy in non-alcoholic fatty liver disease with type 2 diabetes: study protocol for a randomised controlled clinical trial

Lin Y, Zhang Z, Zhong J, Wang Z, Peng Y, Lin Y, Zhang H, Tian J

medRxiv, 2023

Abstract

ABSTRACT:

Background: Nonalcoholic fatty liver disease (NAFLD) is strongly associated with type 2 diabetes (T2DM). Lifestyle intervention remains a preferred treatment modality for NAFLD. As the glucose-lowering agents, glucagon-like peptide (GLP-1) receptor agonists and sodium-glucose cotransporter-2 (SGLT-2) inhibitors have been demonstrated to improve liver fat content and glycaemic control in patients with NAFLD and T2DM. However, studies exploring the efficacy of GLP-1 receptor agonists combined with SGLT-2 inhibitors in patients with NAFLD and T2DM are scanty. Thus, the present randomised controlled trial aims at comparing the efficacy and safety of semaglutide plus empagliflozin with each treatment alone in patients with NAFLD and T2DM.

Methods: This 52-week double-blinded, randomised, parallel-group, active-controlled trial evaluates the effects of semaglutide, empagliflozin and semaglutide + empagliflozin in 105 eligible overweight/obese subjects with NAFLD and T2DM. The primary outcome will be a change from baseline to week 52 in the controlled attenuation parameter, free fatty acid and glucagon. Secondary endpoints include changes in liver stiffness measurement, liver enzymes, blood glucose, lipid levels, renal function, electrolyte balances, minerals and bone metabolism, cytokines, high-sensitivity C-reactive protein, ferritin, anthropometric indicators, nonalcoholic fatty liver fibrosis score, fibrosis 4 score and homeostatic model assessment for insulin…

How strong is the evidence?

Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design.

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