P-96 LONG-TERM PIOGLITAZONE TREATMENT AND LIVER STIFFNESS IN MASLD PATIENTS: INSIGHTS FROM A MULTICENTRIC STUDY

Abstract

Conflict of interest: No Introduction and Objectives: Pioglitazone, an agonist of peroxisome proliferator-activated receptor gamma, has shown efficacy in improving indirect markers of liver steatosis, inflammation, and fibrosis. It also addresses systemic and adipose tissue insulin resistance in patients with type 2 diabetes and metabolic dysfunction-associated fatty liver disease (MASLD). This study aims to evaluate whether sustained consumption of pioglitazone over 12-24 months can improve liver stiffness in individuals diagnosed with biopsy- proven metabolic dysfunction-associated steatohepatitis (MASH). Patients / Materials and Methods: Retrospective data from 56 MASLD patients who received pioglitazone treatment for 12-24 months (15-30 mg daily) were gathered from three public hospitals in Brazil. Vibration-controlled transient elastography [VCTE (FibroscanTM)] was performed before and after pioglitazone treatment as a non-invasive method to monitor disease progression. Additionally, a thorough analysis of both laboratory and clinical data was conducted. Results and Discussion: Most participants were female (63%, n = 35) and obese (BMI 31.1 ± 5.2) with a mean age of 58.4 ± 11.4 years. Initially, participants mostly had hypertension (71%, n = 40) and type II diabetes (61%, n = 34). During the second evaluation, the number of subjects with dyslipidemia and statin use increased. Initially, the liver stiffness measurement (LSM) median was 8.1 kPa (Min: 2.8; Max: 35.3) and 7.2 kPa (Min: 3.5; Max: 32.9) at the second evaluation. Prolonged pioglitazone treatment demonstrated LSM attenuation in 63% of cases (n = 35), resulting in an absolute reduction ranging from 0.1 to 14.4 kPa and a relative reduction ranging from 1.25% to 40.8%. Further analysis comparing the group with improved versus the group with worsened liver stiffness showed a decrease in the CAP parameter, FAST score, and levels of ALT, AST, GGT, TG, and ferritin. Conclusions: The administration of pioglitazone for 12 to 24 months effectively reduced hepatic inflammation and enhanced VCTE parameters in 63% of cases.