Clinical trial NCT04642261: Effect of Empagliflozin on Liver Fat in Non-diabetic Patients
Official title: Effect of Empagliflozin on Liver Fat in Non-alcoholic Fatty Liver Disease Patients Without Diabetes Mellitus: a Randomized, Double-blind, Placebo-controlled Trial
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: PHASE4
Conditions: Non-alcoholic Fatty Liver Disease
Keywords: NAFLD
NASH
fatty liver
empagliflozin
SGLT2 inhibitors
Lead sponsor: The University of Hong Kong
Sponsor class: OTHER
Collaborators: name: Food and Health Bureau, Hong Kong
First posted: 2020-11-24
Enrollment: 98
Sex: ALL
Minimum age (years): 18
Maximum age (years): 80
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Intervention model description: Eligible subjects will be randomly allocated to either the empagliflozin group or placebo group (i.e. control group)
Primary purpose: TREATMENT

Brief summary: Non-alcoholic fatty liver disease (NAFLD) is a global epidemic with a prevalence of 25%. Currently therapies for NAFLD patients without diabetes mellitus (DM) are limited, and are associated with various adverse side effects. Sodium-glucose cotransporter type-2 (SGLT2) inhibitors can reduce hepatic fat content in patients with DM. However, the role of SGLT2 inhibitors in NAFLD patients without DM has not been investigated. Magnetic resonance imaging-derived proton density fat fraction (MRI-PDFF) and liver stiffness measurement (LSM) are non-invasive methods to diagnose hepatic steatosis and fibrosis/cirrhosis, respectively.

The investigators propose a double-blind, randomized, placebo-controlled trial to compare the effects of empagliflozin (a type of SLGT2 inhibitors) versus placebo (in a 1:1 ratio) in reducing hepatic fat content as measured by MRI-PDFF in NAFLD patients without DM. A total of 98 adult patients will be randomly sampled from the liver clinic in our local hospital. Empagliflozin 10mg daily will be given to the treatment arm. The placebo pill will be manufactured to be identical in appearance to the study drug. Eligible subjects will be followed up until week 52, and will undergo clinical, anthropometric and laboratory assessments (including liver function test and fasting blood) at baseline, week 6, 12, 26, 40 and 52. They will undergo LSM at baseline, week 26 and 52, and MRI-PDFF at baseline and week 52. The primary outcome will be a difference in change of liver fat content (measured by MRI-PDFF) at week 52 from baseline between the two groups.

The study results will determine whether SGLT2 inhibitors can reduce hepatic steatosis in NAFLD patients without DM.

Detailed description: Non-alcoholic fatty liver disease (NAFLD) is a global epidemic with a prevalence of 25%. Currently therapies for NAFLD patients without diabetes mellitus (DM) are limited, and are associated with various adverse side effects. Sodium-glucose cotransporter type-2 (SGLT2) inhibitors are antidiabetic drugs that reduce hepatic fat content in patients with DM, which is independent of glycemic control. However, the role of SGLT2 inhibitors in NAFLD patients without DM has not been investigated. Magnetic resonance imaging-derived proton density fat fraction (MRI-PDFF) is an emerging non-invasive imaging technique, and is more sensitive than liver biopsy/histology in quantifying liver fat change. Liver stiffness measurement (LSM) by transient elastography is a non-invasive method to diagnose fibrosis/cirrhosis with high accuracy.

The novelty of utilizing the concept of "drug repositioning" by changing the role of SGLT2 inhibitors in treating DM to treating NAFLD in patients without DM deserves exploration. The investigators propose a double-blind, randomized, placebo-controlled trial to compare the effects of empagliflozin (a type of SLGT2 inhibitors) versus placebo (in a 1:1 ratio) in reducing hepatic fat content as measured by MRI-PDFF in NAFLD patients without DM. A total of 98 adult patients will be randomly sampled from the liver clinical in our local hospital. Empagliflozin 10mg daily will be given to the treatment arm. The placebo pill will be manufactured to be identical in appearance to the study drug. Eligible subjects will be followed up until week 52, and will undergo clinical, anthropometric and laboratory assessments (including liver function test and fasting blood) at baseline, week 6, 12, 26, 40 and 52. They will undergo LSM at baseline, week 26 and 52, and MRI-PDFF at baseline and week 52. The primary outcome will be a difference in change of liver fat content (measured by MRI-PDFF) at week 52 from baseline between the two groups. The secondary outcomes will be remission of steatosis (MRI-PDFF \<5%) at week 52, reduction of liver fibrosis (LSM) at week 26 and 52, improvement of laboratory results (including liver transaminases and ductal enzymes, fasting glucose, HbA1c, lipid profile), improvement of anthropometric measurements, and combined cardiovascular and cerebrovascular events.

The study results will determine whether SGLT2 inhibitors can reduce hepatic steatosis and regress fibrosis in NAFLD patients without DM.

Eligibility criteria: Inclusion Criteria:

* Potential study subjects will first be screened by transient elastography for the presence of hepatic steatosis (defined as a measurement of controlled attenuation parameter \[CAP\] \>= 248 db/M).
* They will be recruited into study if steatosis is \>= 5% as confirmed by MRI-PDFF

Exclusion Criteria:

* DM (defined as hemoglobin A1c \[HbA1c\] \>= 6.5% or fasting glucose \>= 7.0 mmol/L)
* alcohol intake \> 20g within past 2 years
* concurrent chronic liver diseases (including chronic viral hepatitis infection, autoimmune hepatitis, Wilson's disease, hemochromatosis, congestive hepatopathy, primary biliary cholangitis, primary sclerosing cholangitis, biliary tract obstruction)
* drug-induced liver disease
* usage of drugs that can lead to hepatic steatosis (e.g. steroids, amiodarone, valproate, methotrexate, tamoxifen)
* decompensated cirrhosis (including ascites, hepatic hydrothorax, variceal bleeding, hepatic encephalopathy, hepatorenal syndrome, hepatopulmonary syndrome)
* history of malignancy including HCC
* recreational substance abuse
* pregnancy
* contraindications to empagliflozin use (estimated glomerular filtration rate \[eGFR\] \<45mL/min/1.73m2 as measured by the MDRD equation, history of recurrent genitourinary tract infections, gangrene, or allergy)
* contraindications to MRI (e.g., claustrophobia, certain cardiac pacemakers, implanted medical devices with ferromagnetic properties).

Primary outcomes:
measure: Change in liver fat content
timeFrame: week 52
Secondary outcomes:
measure: Remission of steatosis
timeFrame: week 52
measure: Change of liver fat content
timeFrame: week 26 and 52
measure: Changes of alanine aminotransferase (ALT)
timeFrame: week 52
measure: Changes of aspartate aminotransferase (AST)
timeFrame: week 52
measure: Changes of alkaline phosphatase (ALP)
timeFrame: week 52
measure: Changes of gamma glutamyl transferase (GGT)
timeFrame: week 52
measure: Changes of fasting glucose
timeFrame: week 52
measure: Changes of haemoglobin A1c (HbA1c)
timeFrame: week 52
measure: Changes of total cholesterol
timeFrame: week 52
measure: Changes of low density lipoprotein (LDL)
timeFrame: week 52
measure: Changes of high density lipoprotein (HDL)
timeFrame: week 52
measure: Changes of body weight
timeFrame: week 52
measure: Changes of height
timeFrame: week 52
measure: Changes of body mass index (BMI)
timeFrame: week 52
measure: Changes of waist circumference
timeFrame: week 52
measure: Changes of systolic blood pressure
timeFrame: week 52
measure: Changes of diastolic blood pressure
timeFrame: week 52
Other outcomes:
Locations:
city: Hong Kong
country: Hong Kong
facility: The University of Hong Kong/Queen Mary Hospital
state: Hong Kong, China
Study officials:
affiliation: The University of Hong Kong
name: Ka Shing Cheung, MD, MPH
role: PRINCIPAL_INVESTIGATOR
References: