Twelve week liraglutide or sitagliptin does not affect hepatic fat in type 2 diabetes: a randomised placebo-controlled trial

Abstract

Aims/hypothesis: Glucagon-like peptide (GLP)-1-based therapies have been suggested to improve hepatic steatosis. We assessed the effects of the GLP-1 receptor agonist liraglutide and the dipeptidyl peptidase (DPP)-4 inhibitor sitagliptin on hepatic steatosis and fibrosis in patients with type 2 diabetes.

Methods: In this 12 week, parallel, randomised, placebo-controlled trial, performed at the VU University Medical Center between July 2013 and August 2015, 52 overweight patients with type 2 diabetes treated with metformin and/or sulphonylurea agent ([mean ± SD] age 62.7 ± 6.9 years, HbA_1c 7.3 ± 0.7% or 56 ± 1 mmol/mol) were allocated to once daily liraglutide 1.8 mg (n = 17), sitagliptin 100 mg (n = 18) or matching placebos (n = 17) by computer generated numbers. Both participants and researchers were blinded to group assignment. Hepatic fat content was measured using proton magnetic resonance spectroscopy (¹H-MRS). Hepatic fibrosis was estimated using three validated formulae.

Results: One patient dropped out in the sitagliptin group owing to dizziness, but no serious adverse events occurred. At week 12, no between-group differences in hepatic steatosis were found. Liraglutide reduced steatosis by 10% (20.9 ± 3.4% to 18.8 ± 3.3%), sitagliptin reduced steatosis by 12.1% (23.9 ± 3.0% to 21.0 ± 2.7%) and placebo lessened it by 9.5% (18.7 ± 2.7% to 16.9 ± 2.7%). Neither drug affected hepatic fibrosis scores compared with placebo.

Conclusions/interpretation: Twelve-week liraglutide or sitagliptin treatment does not reduce hepatic steatosis or fibrosis in type 2 diabetes.

Trial registration: ClinicalTrials.gov NCT01744236 FUNDING : Funded by the European Community's Seventh Framework Programme (FP7/2007-2013) under grant agreement no. 282521 - the SAFEGUARD project.

Keywords: Dipeptidyl peptidase-4 inhibitor; Glucagon-like peptide-1 receptor agonist; Non-alcoholic fatty liver disease; Type 2 diabetes.

Fig. 1

Effects of treatment on ¹H-MRS-measured hepatic fat content and calculated fibrosis. Effects of liraglutide, sitagliptin or placebo on hepatic endpoints. White bars, measurements at baseline; grey bars, measurements at 12 weeks. (a, b) Hepatic fat content as measured using ¹H-MRS, with individual effects shown in (b). Markers of hepatic fibrosis: (c) NFS; (d) FIB-4; (e) APRI. Data are mean ± SEM. None of the effects was statistically significant (p < 0.05)