Pioglitazone: An Addition to Our Toolbox for Patients With Diabetes and Nonalcoholic Steatohepatitis?
Authors: Eduardo Vilar-Gomez, Leon A. Adams
Journal: Annals of Internal Medicine (2016)

Editorials6 September 2016Pioglitazone: An Addition to Our Toolbox for Patients With Diabetes and Nonalcoholic Steatohepatitis?Eduardo Vilar-Gomez, MD, PhD and Leon A. Adams, MBBS, PhDEduardo Vilar-Gomez, MD, PhDFrom University of Seville, Seville, Spain, and University of Western Australia, Nedlands, Australia.Search for more papers by this author and Leon A. Adams, MBBS, PhDFrom University of Seville, Seville, Spain, and University of Western Australia, Nedlands, Australia.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M16-1303 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Nonalcoholic fatty liver disease (NAFLD) is a growing global public health problem and is now recognized as the most common cause of chronic liver disease in the United States and other industrialized countries (1). The prevalence of NAFLD has increased in parallel with the dramatic increase in obesity and type 2 diabetes mellitus (T2DM), and it is now estimated to occur in more than 30% of the adult U.S. population (1). Although most patients with NAFLD have simple steatosis and a relatively benign clinical course, a smaller proportion develop nonalcoholic steatohepatitis (NASH), which may progress to cirrhosis and liver cancer ...References1. Chalasani N, Younossi Z, Lavine JE, Diehl AM, Brunt EM, Cusi K, et al; American Gastroenterological Association. The diagnosis and management of non-alcoholic fatty liver disease: practice guideline by the American Gastroenterological Association, American Association for the Study of Liver Diseases, and American College of Gastroenterology. Gastroenterology. 2012;142:1592-609. [PMID: 22656328] doi:10.1053/j.gastro.2012.04.001 CrossrefMedlineGoogle Scholar2. Adams LA, Lymp JF, St Sauver J, Sanderson SO, Lindor KD, Feldstein A, et al. The natural history of nonalcoholic fatty liver disease: a population-based cohort study. Gastroenterology. 2005;129:113-21. [PMID: 16012941] CrossrefMedlineGoogle Scholar3. Angulo P, Kleiner DE, Dam-Larsen S, Adams LA, Bjornsson ES, Charatcharoenwitthaya P, et al. Liver fibrosis, but no other histologic features, is associated with long-term outcomes of patients with nonalcoholic fatty liver disease. Gastroenterology. 2015;149:389-97. [PMID: 25935633] doi:10.1053/j.gastro.2015.04.043 CrossrefMedlineGoogle Scholar4. Adams LA, Harmsen S, StSauver JL, Charatcharoenwitthaya P, Enders FB, Therneau T, et al. Nonalcoholic fatty liver disease increases risk of death among patients with diabetes: a community-based cohort study. Am J Gastroenterol. 2010;105:1567-73. [PMID: 20145609] doi:10.1038/ajg.2010.18 CrossrefMedlineGoogle Scholar5. Vilar-Gomez E, Martinez-Perez Y, Calzadilla-Bertot L, Torres-Gonzalez A, Gra-Oramas B, Gonzalez-Fabian L, et al. Weight loss through lifestyle modification significantly reduces features of nonalcoholic steatohepatitis. Gastroenterology. 2015;149:367-78. [PMID: 25865049] doi:10.1053/j.gastro.2015.04.005 CrossrefMedlineGoogle Scholar6. Belfort R, Harrison SA, Brown K, Darland C, Finch J, Hardies J, et al. A placebo-controlled trial of pioglitazone in subjects with nonalcoholic steatohepatitis. N Engl J Med. 2006;355:2297-307. [PMID: 17135584] CrossrefMedlineGoogle Scholar7. Sanyal AJ, Chalasani N, Kowdley KV, McCullough A, Diehl AM, Bass NM, et al; NASH CRN. Pioglitazone, vitamin E, or placebo for nonalcoholic steatohepatitis. N Engl J Med. 2010;362:1675-85. [PMID: 20427778] doi:10.1056/NEJMoa0907929 CrossrefMedlineGoogle Scholar8. Cusi K, Orsak B, Bril F, Lomonaco R, Hecht J, Ortiz-Lopez C, et al. Long-term pioglitazone treatment for patients with nonalcoholic steatohepatitis and prediabetes or type 2 diabetes mellitus. A randomized trial. Ann Intern Med. 2016;165:305-15. doi:10.7326/M15-1774 LinkGoogle Scholar9. Ratziu V, Charlotte F, Bernhardt C, Giral P, Halbron M, Lenaour G, et al; LIDO Study Group. Long-term efficacy of rosiglitazone in nonalcoholic steatohepatitis: results of the Fatty Liver Improvement by Rosiglitazone Therapy (FLIRT 2) extension trial. Hepatology. 2010;51:445-53. [PMID: 19877169] doi:10.1002/hep.23270 CrossrefMedlineGoogle Scholar10. Semenkovich CF. Insulin resistance and a long, strange trip [Editorial]. N Engl J Med. 2016;374:1378-9. [PMID: 26886417] doi:10.1056/NEJMe1600962 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From University of Seville, Seville, Spain, and University of Western Australia, Nedlands, Australia.Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M16-1303.Corresponding Author: Eduardo Vilar-Gomez, MD, PhD, Unit for the Clinical Management of Digestive Diseases, Virgen Macarena-Virgen del Rocio University Hospitals, Institute of Biomedicine, Ciberehd, University of Seville, Manuel Siurot Avenue, s/n, Seville, Spain; e-mail, [email protected]com.Current Author Addresses: Dr. Vilar-Gomez: Unit for the Clinical Management of Digestive Diseases, Virgen Macarena-Virgen del Rocio University Hospitals, Institute of Biomedicine, Ciberehd, University of Seville, Manuel Siurot Avenue, s/n, Seville, Spain.Dr. Adams: School of Medicine and Pharmacology, University of Western Australia, M50, Nedlands, Western Australia 6009, Australia.This article was published at www.annals.org on 21 June 2016. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoLong-Term Pioglitazone Treatment for Patients With Nonalcoholic Steatohepatitis and Prediabetes or Type 2 Diabetes Mellitus Kenneth Cusi , Beverly Orsak , Fernando Bril , Romina Lomonaco , Joan Hecht , Carolina Ortiz-Lopez , Fermin Tio , Jean Hardies , Celia Darland , Nicolas Musi , Amy Webb , and Paola Portillo-Sanchez Metrics Cited byManaging problems with medications for type 2 diabetes 6 September 2016Volume 165, Issue 5Page: 373-374KeywordsFibrosisInsulin resistanceLiverLiver fibrosisMortalityNonalcoholic steatohepatitisPatientsSteatosisWeight loss ePublished: 21 June 2016 Issue Published: 6 September 2016 Copyright & PermissionsCopyright © 2016 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...