Histological impact at 5 years after the start of sodium-glucose cotransporter 2 inhibitor for non-alcoholic steatohepatitis complicated by diabetes mellitus

A retrospective study based on serial liver biopsies was performed to investigate the efficacy of sodium-glucose cotransporter 2 inhibitor (SGLT2i) for non-alcoholic steatohepatitis (NASH) complicated by type 2 diabetes mellitus. Three cases were evaluated for liver histology at four points until 5 years after the start of treatment. All three cases showed a reworsening on physical examination. One case did not show histological change at the fourth biopsy compared to pretreat-ment, but the other two cases maintained histological improvement. All cases did not develop three-point ma-jor adverse cardiovascular events (MACE). In conclu-sion, long-term treatment of SGLT2i for NASH is asso-ciated with long-term improvement in liver histopa-thology. Further large-scale prospective studies are needed to determine the long-term impact for histological features and outcomes, including three-point MACE.