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Pioglitazone Benefits Nonalcoholic Steatohepatitis

Glucose tolerance, liver function improves with combination of drug and dietary changes

WEDNESDAY, Nov. 29 (HealthDay News) -- A hypocaloric diet plus pioglitazone significantly improves glucose tolerance and liver function in patients with nonalcoholic steatohepatitis, according to the results of a proof-of-concept study reported in the Nov. 30 issue of the New England Journal of Medicine.

Kenneth Cusi, M.D., of the University of Texas Health Science Center at San Antonio, and colleagues randomly assigned 55 patients with nonalcoholic steatohepatitis and impaired glucose tolerance or type 2 diabetes to a hypocaloric diet plus either pioglitazone (45 mg per day) or placebo for six months.

Patients receiving pioglitazone had better glycemic control and glucose tolerance, improved hepatic insulin sensitivity, normal liver aminotransferase and decreased serum aminotransferase levels, and reduced hepatic fat content. These patients also had significant improvements in histology in terms of steatosis, ballooning necrosis and inflammation, but not fibrosis. There were no adverse events apart from fatigue and lower-extremity edema in one patient taking pioglitazone.

"Until the results of large, controlled studies of at least one or two years' duration are available, dietary modification, exercise, and treatment of coexisting conditions should be the preferred strategy for managing nonalcoholic steatohepatitis," Arthur J. McCullough, M.D., from Case Western Reserve University in Cleveland, Ohio, comments in an accompanying editorial.

The study was partially supported by Takeda Pharmaceuticals.

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