SGLT2 inhibitors in metabolic dysfunction-associated steatotic liver disease (MASLD/NAFLD): Mechanisms, clinical benefits, and outcomes

Metabolic dysfunction-associated steatohepatitis (MASH) represents a progressive form of metabolic dysfunction-associated steatotic liver disease (MASLD) and contributes significantly to morbidity and mortality in developed countries. Current clinical practice primarily relies on dietary and lifestyle modifications, while specialized obesity management is used less frequently. However, the long-term efficacy of these approaches remains unsatisfactory. Among pharmacological options, gliflozins have emerged as a promising class of agents with potential benefits in reducing histological activity and improving the prognosis of MASLD/MASH. The beneficial effects of gliflozins in diabetes, cardiology, and nephrology have already been demonstrated, and their use is becoming increasingly common across various clinical indications. However, their role in the treatment of MASLD/MASH has not yet been fully clarified. Preliminary studies suggest that gliflozins may positively influence disease progression in these conditions. This article provides a comprehensive overview of MASLD/MASH and reviews current evidence regarding the therapeutic effects of gliflozins on these liver diseases.