ECE2024 Poster Presentations Diabetes, Obesity, Metabolism and Nutrition (130 abstracts)
Comparison between most recent guidelines about NAFLD medical treatment
Irene Samperi 1 , Marco Grasso 2 , Maria Chantal Ponziani 3 , Alberto Carpenito 4 , Francesco Tassone 5 , Carla Micaela Cuttica 6 , Filippo Egalini 7 , Roberta Guido 8 , Morena Pisarro 9 , Isabella Buffardi 9 & Anna Nelva 10
1SSD of Diabetology and Metabolic Diseases- - Azienda Sanitaria Locale Novara, Novara, Italy; 2Diabetology, Ospedale di Cittadella, Padova, Italy; 3SSD of Diabetology and Metabolic Diseases - Azienda Sanitaria Locale Novara, Novara, Italy; 4CAD Montoro-asl Avellino, Avellino, Italy; 5SC Endocrinologia, Diabetologia & Metabolismo, ASO Santa Croce & Carle di Cuneo, Cuneo, Italy; 6Unit of Endocrinology, Galliera Hospital, Genoa, Italy; 7Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, University of Turin, Turin, Italy; 8Diabetology, ASL3 genovese, genoa, Italy; 9Endocrinology, Rome, Italy; 10Endocrinology, Biella, Italy
Background: Given the high prevalence of Nonalcoholic Fatty Liver Disease (NAFLD) in clinical endocrinology, diabetology, and primary care practice, international societies have addressed guidelines to drive clinicians in screening, diagnosis, and treatment for this condition.
Aim: compare the most recent guidelines to address similarities and differences and help clinicians choosing the most updated evidence. We considered Italian guidelines (2021), AACE-AASLD guideline (2022) and AASLD Practice Guidance (2023). Herein we present findings about pharmacotherapy.
Results: Italian guidelines used Methodological Manual for clinical practice guidelines developed by the Italian Istituto Superiore di Sanità, using the PICO approach. AACE guideline was conducted by a clinical practice committee that selected and graded articles. Recommendations were made on the grade for the quality of the literature and on expert opinion. AASLD didn’t use a grading system therefore they present statements from experts, based on available literature, rather than recommendations. Guidelines address medication with different strengths and in a personalized approach as shown in the table.
| Medication | Italian | AACE | AASLD |
| Vitamin E | Suggested | Consider in patients without DM | Consider |
| GLP1ra | Limited data | Recommended in patients with Dm2 and biopsy NASH+Recommended for the use of obesity and NAFLD Consider in patients with DM and a high probability of NASH | Consider Semaglutide in patients with DM and obesity |
| Pioglitazone | Suggested | Recommended in patients with Dm2 and biopsy NASH+ Consider in patients with DM and a high probability of NASH | Consider in patients with DM |
| SGLT2i | Not suggested | No evidence | Limited data |
| DPP4i | Not suggested | Non recommended | Not indicated |
| Metformin | Not suggested | Non recommended | NA |
| Acarbose | NA | Non recommended | NA |
| Insulin | NA | Non recommended | NA |
| Orlistat | NA | Potential effect | NA |
| Naltrexone/bupropion | NA | Potential effect | NA |
| Ursodeoxycholic acid | Not suggested | NA | Not indicated |
| Obeticholic acid | Suggested (not yet approved) | NA | Limited data |
| Statins | NA | NA | Not indicated |
| Silymarin | NA | NA | Limited data, not indicated |
| NA: Not available | |||
Conclusion: The prevalence of NAFLD is increasing worldwide and more efforts are being made to diagnose and treat this condition. Recently nomenclature has changed to MASLD (metabolic dysfunction-associated steatotic liver disease) to include patients with fatty liver regardless of the amount and pattern of alcohol intake with metabolic comorbidities (hypertension, dyslipidemia, overweight or high weight circumference, pre-diabetes or diabetes). Despite having no specific treatment approved for this condition several medications have been used. Guidelines underline the need to tailor the treatment based on patient comorbidities
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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