Evidence mapPaperPMID 42265474Full record

SynthesisEuropean journal of clinical pharmacology2026

SGLT2 inhibitors and incretin-based therapies for metabolic dysfunction-associated steatohepatitis: a systematic review.

Artur Macedo Cruz, Bruna Carolyne Venancio Lima, José Erivelton Souza Maciel de Ferreira, Rian Brito Teles

Abstract readSystematic Review
In one paragraph

Synthesis in European journal of clinical pharmacology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

What it found

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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

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3 · Its place in the literature

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4 · The record

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5 · Who and what money

Authors and funding

4 authors.

Artur Macedo CruzUniversity of Gurupi, Gurupi, Tocantins, Brazil.ORCID http://orcid.org/0000-0002-7580-7584
Bruna Carolyne Venancio LimaEstácio Faculty of Medicine of Juazeiro do Norte, Ceará, Brazil.
José Erivelton Souza Maciel de FerreiraUniversity for the International Integration of the Afro-Brazilian Lusophony (UNILAB), Ceará, Brazil. eriveltonsmf@aluno.unilab.edu.br.ORCID http://orcid.org/0000-0003-2668-7587
Rian Brito TelesMedical Residency in Internal Medicine, Idomed Quixadá, Ceará, Brazil.ORCID http://orcid.org/0009-0009-1700-2225

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundIn recent years, metabolic therapies originally developed to treat systemic metabolic disorders have been investigated as potential therapeutic strategies for Metabolic dysfunction-associated steatohepatitis (MASH).

objectiveThis study aimed to critically evaluate recent clinical evidence on emerging metabolic therapies, particularly sodium-glucose cotransporter-2 (SGLT2) inhibitors and incretin-based agents, examining their effects on hepatic and metabolic outcomes and, when available, histological endpoints, as well as safety in patients with MASH.

methodsA systematic review of clinical studies evaluating metabolic therapies in patients with MASH or metabolically associated fatty liver disease was conducted. Randomized clinical trials and other relevant clinical studies investigating SGLT2 inhibitors, incretin-based therapies, and other emerging metabolic agents were included. Outcomes of interest comprised metabolic parameters, hepatic outcomes related to steatosis and disease activity, and histological endpoints when available.

resultsTwelve clinical studies were included. In trials with histological endpoints, semaglutide achieved steatohepatitis resolution without worsening of fibrosis in 62.9% versus 34.3% with placebo in a phase 3 trial (p < 0.001), while a phase 2 trial reported NASH resolution in 59% versus 17% with placebo (p < 0.001), without significant fibrosis improvement (43% versus 33%; p = 0.48). Tirzepatide achieved MASH resolution without worsening of fibrosis in 44-62% of patients versus 10% with placebo (p < 0.001 for all doses), and fibrosis improvement in 51-55% versus 30%. Among SGLT2 inhibitors, dapagliflozin achieved MASH improvement without worsening of fibrosis in 53% versus 30% (p = 0.006), MASH resolution in 23% versus 8% (p = 0.01), and fibrosis improvement in 45% versus 20% (p = 0.001). Overall, metabolic therapies improved body weight, hepatic steatosis, glycemic parameters, and disease activity, but evidence for durable fibrosis regression and long-term liver-related outcomes remains heterogeneous.

conclusionEmerging metabolic therapies show promising effects on metabolic and hepatic outcomes in patients with MASH. Incretin-based therapies appear to exert particularly robust effects on body weight reduction and steatohepatitis resolution, whereas SGLT2 inhibitors may provide complementary metabolic, cardiometabolic, and hepatic benefits. Nevertheless, fibrosis-related effects remain less consistent across studies, and future trials with paired histological endpoints, longer follow-up, and clinically meaningful liver-related outcomes are needed.

Indexed as

Fatty LiverIncretinsMetabolic DiseasesSodium-Glucose Transporter 2 InhibitorsHumansSemaglutideIncretinsSemaglutideSodium-Glucose Transporter 2 InhibitorsGlucagon-Like Peptide-1 Receptor AgonistsInsulin ResistanceMetabolic DiseasesMetabolic dysfunction-associated steatohepatitisSodium-Glucose Transporter 2 Inhibitors

Identifiers

PMID42265474
PMCPMC13249686

What Socratic holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.