A popular drug for treating obesity and diabetes is showing benefits in the fight against a deadly liver disease.

Semaglutide, sold under names including Ozempic and Wegovy, aids weight loss and blood sugar regulation by mimicking the natural hormone GLP-1, which curbs appetite and triggers insulin release. Researchers have found that the drug can also stop - and in some cases even reverse - a condition known as steatohepatitis associated with metabolic dysfunction (MASH).

"This potentially offers a fundamental approach to treating this condition. It's quite exciting for patients," said Philip Newsome from King's College London.

MASH, formerly called NASH, is the severe form of non-alcoholic fatty liver disease characterised by increased fat accumulation in the liver. This leads to inflammation and fibrosis - scarring - and sometimes to cirrhosis and cancer. MASH is commonly associated with obesity and often with type 2 diabetes.

In a 2020 study of 320 people, Newsom and colleagues found that daily injections of semaglutide led to a reduction in liver fat and inflammation in 59% of people with MASH. But a more recent study in 71 patients showed no benefit from the weekly regimen.

To get a broader picture, Newsom and Arun Sanyal of Virginia Commonwealth University began a larger study involving 1,195 MASH patients at 253 clinical sites in 37 countries. On average, participants were 56 years old with a body mass index of 34.6. About half had type 2 diabetes.

Doctors prescribed each participant a weekly injection of either semaglutide or placebo to take for 4 1/2 years. The dose, gradually increased over the first four months to 2.4 milligrams, matched that used in Wegovy and was chosen based on the results of earlier studies. Patients were also offered lifestyle counseling to encourage healthy eating and exercise.

Although the entire study period was ongoing, after 72 weeks, the researchers analyzed the biopsy results of the first 800 patients, including 266 who had placebo injections. They found that 62.9% of those taking semaglutide experienced a significant reduction in liver fat and inflammation, compared to 34.3% of the placebo group. Fibrosis improved in 36.8% of the treatment group, but in only 22.4% of the placebo group. About one-third of all treated patients and 16.1% of placebo patients experienced both of these benefits.

The weight loss itself may have contributed to these improvements, as people in the treatment group lost an average of 10.5% of their body weight, compared with only 2% of the body weight of those on placebo. But the treatment itself may also be directly targeting the process causing the disease, although further research is needed to fully understand the mechanisms.

"Nothing is proven yet, but it may be that part of the effect of GLP-1-like drugs is that they act on immune cells to mitigate inflammation," Newsom said. | BGNES