Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Aug 27, 2020; 12(8): 493-505
Published online Aug 27, 2020. doi: 10.4254/wjh.v12.i8.493
Glucagon-like peptide-1 receptor agonists in non-alcoholic fatty liver disease: An update
Areti Sofogianni, Athanasios Filippidis, Lampros Chrysavgis, Konstantinos Tziomalos, Evangelos Cholongitas
Areti Sofogianni, Athanasios Filippidis, Konstantinos Tziomalos, First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki 54636, Greece
Lampros Chrysavgis, Evangelos Cholongitas, First Department of Internal Medicine, Laiko General Hospital, Medical School of National and Kapodistrian University of Athens, Athens 11527, Greece
Author contributions: Sofogianni A, Filippidis A and Chrysavgis L drafted the review; Tziomalos K and Cholongitas E critically revised the draft.
Conflict-of-interest statement: There is no conflict of interest associated with any of the senior author or other coauthors contributed their efforts in this manuscript.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Evangelos Cholongitas, MD, PhD, Associate Professor, First Department of Internal Medicine, Laiko General Hospital, Medical School of National and Kapodistrian University of Athens, Agiou Thoma 17, Athens 11527, Greece.
Received: March 16, 2020
Peer-review started: May 16, 2020
First decision: April 26, 2020
Revised: May 2, 2020
Accepted: June 20, 2020
Article in press: June 20, 2020
Published online: August 27, 2020

Non-alcoholic fatty liver disease (NAFLD) is the predominant cause of chronic liver disease worldwide. NAFLD progresses in some cases to non-alcoholic steatohepatitis (NASH), which is characterized, in addition to liver fat deposition, by hepatocyte ballooning, inflammation and liver fibrosis, and in some cases may lead to hepatocellular carcinoma. NAFLD prevalence increases along with the rising incidence of type 2 diabetes mellitus (T2DM). Currently, lifestyle interventions and weight loss are used as the major therapeutic strategy in the vast majority of patients with NAFLD. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are used in the management of T2DM and do not have major side effects like hypoglycemia. In patients with NAFLD, the GLP-1 receptor production is down-regulated. Recently, several animal and human studies have emphasized the role of GLP-1RAs in ameliorating liver fat accumulation, alleviating the inflammatory environment and preventing NAFLD progression to NASH. In this review, we summarize the updated literature data on the beneficial effects of GLP-1RAs in NAFLD/NASH. Finally, as GLP-1RAs seem to be an attractive therapeutic option for T2DM patients with concomitant NAFLD, we discuss whether GLP-1RAs should represent the first line pharmacotherapy for these patients.

Keywords: Glucagon-like peptide-1 receptor agonists, Non-alcoholic fatty liver disease, Type 2 diabetes mellitus, Clinical studies, Fatty liver, Animal studies

Core tip: The strong relationship between non-alcoholic fatty liver disease (NAFLD) and type 2 diabetes mellitus points to a need to evaluate the therapeutic potential of antidiabetic drugs in patients with NAFLD. Accordingly, glucagon-like peptide-1 receptor agonists, which are well-tolerated antidiabetic agents with no risk of hypoglycemia, seem to be a very appealing therapeutic option for type 2 diabetes mellitus patients with NAFLD. Herein, based on data from animal studies and clinical trials, we discuss the beneficial impact of glucagon-like peptide-1 receptor agonists on NAFLD.