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Effect of SGLT-2 inhibitors on liver fibrosis progression in patients with MASLD: an updated meta-analysis based on

Lei Yang1, Jiale Ruan2, Yingying Fang2

  • 1Emergency Medical Center, Ningbo Hospital of Integrated Traditional Chinese and Western Medicine, Ningbo, Zhejiang, China.

Frontiers in Medicine
|February 5, 2026
PubMed
Abstract

Insights

Sodium-glucose cotransporter protein 2 (SGLT-2) inhibitors show promise in slowing liver fibrosis progression in metabolic dysfunction-associated steatohepatitis (MASLD). These drugs significantly improved serologic markers of fibrosis, suggesting potential clinical benefits.

Area of Science:

  • Hepatology
  • Endocrinology
  • Pharmacology

Background:

  • Non-alcoholic fatty liver disease (NAFLD), now termed metabolic dysfunction-associated steatohepatitis (MASLD), is a growing health concern.
  • Liver fibrosis is a key driver of MASLD progression and adverse outcomes.
  • Identifying effective therapeutic strategies to halt or reverse liver fibrosis is critical.

Purpose of the Study:

  • To evaluate the efficacy of sodium-glucose cotransporter protein 2 (SGLT-2) inhibitors in mitigating liver fibrosis progression in patients with MASLD.
  • To assess the impact of SGLT-2 inhibitors on various non-invasive fibrosis markers.

Main Methods:

  • Systematic literature search of randomized controlled trials (RCTs) across major databases (PubMed, Web of Science, Embase, Cochrane Library) up to February 2025.
  • Meta-analysis of 16 RCTs involving 11,300 patients to determine the mean difference (MD) and 95% confidence intervals (CIs) for fibrosis indicators.
  • Assessment of Fib-4 index, NAFLD fibrosis score (NFS), liver stiffness measurement (LSM), controlled attenuation parameter (CAP), and serum type 4 collagen 7s levels.

Main Results:

  • SGLT-2 inhibitors significantly reduced Fib-4 index (MD = -0.16), NFS (MD = -0.10), and serum type 4 collagen 7s levels (MD = -0.35) compared to controls.
  • No significant changes were observed in imaging-based metrics like LSM and CAP.
  • Subgroup analyses suggested potential greater efficacy for empagliflozin and ipragliflozin, particularly in short-term treatment (<24 weeks) and patients with type 2 diabetes mellitus (T2DM).

Conclusions:

  • SGLT-2 inhibitors demonstrate potential in delaying liver fibrosis progression in MASLD patients, primarily through improvements in serologic markers.
  • The findings suggest a beneficial role for SGLT-2 inhibitors in managing MASLD-related liver fibrosis.
  • Further high-quality research is warranted to confirm the clinical utility and long-term benefits of SGLT-2 inhibitors in this patient population.
Keywords:
SGLT-2 inhibitorsliver fibrosismeta-analysismetabolic dysfunction-associated fatty liver diseasenonalcoholic fatty liver disease

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