Improvements in Liver Enzymes with Empagliflozin in the EMPA-REG OUTCOME Trial
Abstract
Empagliflozin (EMPA) reduces weight and HbA1c in patients with T2DM, but it is not known if it leads to reductions in elevated liver enzymes reflective of liver fat. We investigated the effect of EMPA on liver transaminases in the EMPA-REG OUTCOME trial. Patients with T2DM and established CV disease were randomized to receive EMPA 10 mg, EMPA 25 mg, or placebo (PBO) in addition to standard of care. Changes from baseline in alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were assessed in all treated patients (N=7020) and in tertiles by baseline ALT or AST. In the EMPA group, ALT decreased from baseline to week 28 and then remained stable. In the PBO group, ALT declined steadily to a lesser extent. Reductions in ALT were greatest in the highest tertile of baseline ALT (tertile 3). In the lowest tertile, changes in ALT were similar between EMPA and PBO. AST decreased from baseline to week 28 and then remained stable with EMPA; there were no relevant changes with PBO. Changes from baseline in AST were generally similar between EMPA and PBO at weeks 28 and 164 in the second and third tertiles, but were greater with EMPA than PBO in the highest tertile by baseline AST. Similar patterns were observed in analysis of pooled Phase III trial data and a trial of EMPA vs. glimepiride. In conclusion, EMPA reduced ALT and AST vs. PBO in the EMPA-REG OUTCOME trial, with greater reductions in ALT than AST, in a pattern consistent with a reduction in liver fat. Disclosure…
How strong is the evidence?
Evidence Hub reads this as a randomized trial. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design. Reported size: 7,020 participants or records.
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