A medicine already widely used for diabetes and weight loss may also help people with a serious form of fatty liver disease.
A large international clinical trial found that semaglutide reduced liver inflammation and, in some patients, also reduced liver scarring.
Semaglutide is the active medicine used in drugs prescribed for type 2 diabetes and weight management.
It works partly by copying the effects of a natural hormone that helps control blood sugar, appetite and how much food people eat.
Researchers have now tested whether the medicine can also help people with a liver condition known as MASH. This is a more serious stage of fatty liver disease in which excess fat in the liver is accompanied by inflammation and damage to liver cells.
Fatty liver disease is strongly linked with obesity, type 2 diabetes and other problems involving the way the body uses and stores energy. Many people have few or no symptoms in the early stages, so liver damage can develop quietly for years.
For some people, continued inflammation causes scar tissue to form in the liver. Severe scarring can eventually lead to cirrhosis, liver failure or liver cancer.
The new findings come from the ESSENCE phase 3 clinical trial, a large study designed to test semaglutide in people with MASH and moderate to advanced liver scarring. The trial was conducted at more than 250 medical centers across 37 countries.
In the first major analysis, researchers studied about 800 participants who received either a weekly injection of semaglutide or a placebo for 72 weeks. Everyone in the trial also received advice about healthy eating and other lifestyle changes.
Most of the participants were living with obesity, and more than half had type 2 diabetes. These conditions are common among people with this type of liver disease.
The results showed a clear difference between the two groups. About 63% of people receiving semaglutide had their MASH improve without their liver scarring becoming worse, compared with about 34% of those receiving the placebo.
Semaglutide also appeared to help with liver scarring itself. About 37% of patients taking the medicine showed an improvement in scarring without worsening of MASH, compared with about 22% in the placebo group.
People taking semaglutide also lost considerably more weight. On average, their body weight fell by about 10%, while people receiving the placebo lost much less.
The treatment was also linked with improvements in several measures of liver health. This is important because weight loss and better control of blood sugar and other metabolic problems may reduce some of the pressures that contribute to fatty liver disease.
The findings do not mean semaglutide is a cure for liver disease. Researchers still need to determine whether the improvements seen in the trial translate into fewer cases of cirrhosis, liver failure, liver cancer or other serious health problems over many years.
The trial is continuing to help answer those questions. Researchers plan to follow a larger group of nearly 1,200 participants for several years to study longer-term liver outcomes and the safety and benefits of treatment.
The study was led by Professor Philip Newsome of King’s College London and Professor Arun Sanyal of Virginia Commonwealth University School of Medicine, together with an international research team. The trial was funded by Novo Nordisk, the company that makes semaglutide.
The findings were published in the New England Journal of Medicine. As a phase 3 trial, the research provides strong clinical evidence that semaglutide may become an important treatment option for some people with MASH.
The results also highlight how closely liver health is connected with obesity, diabetes and the body’s overall metabolism. A medicine that improves several of these problems at the same time could offer doctors a new way to protect the liver before severe and permanent damage develops.
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