Popular weight loss medicine also appears to help against serious liver disease

To the growing list of chronic diseases that are the popular weight-loss drug semaglutide knows how to cure, a serious, common liver disease can now also be added. The drug appears to significantly reduce the amount of fat and scarring in the liver in patients. As a result, they are likely to be less at risk of cancer or a liver transplant.

Lasting impact

This is evident from a global study of eight hundred patients, published this week in the journal The New England Journal of Medicine. “These weight loss drugs can permanently change our field,” says Harry Janssen, professor of liver diseases at Erasmus MC in Rotterdam.

Over the past seven years, the number of liver transplants due to fatty liver disease in the Netherlands has tripled, to around fifty per year, he says. That's 20 percent of all liver transplants. Because potential donors are also more likely to suffer from fatty liver disease, more livers are rejected.

The number of people with a liver that is too fatty has increased in recent decades. More than a third of the world's population suffers from the condition, which is often the result of an unhealthy lifestyle.

Most people are not affected by the fat in their liver, but 4 percent of the Dutch population has inflammation that can lead to so-called cirrhosis. This inflammation, as it were, nibbles on healthy liver cells, explains Janssen. As a result, scar tissue is formed that impairs the functioning of the liver.

“Fatty liver disease is a silent killer,” he says. “If you get symptoms, treatment is often too late.” He estimates that many hundreds of patients die each year in the Netherlands who have developed cancer or liver failure as a result of a fatty liver.

Weight loss is the explanation

The international study included patients from 37 countries, including the Netherlands. They all had inflammation and scar tissue in their liver. Some of the patients received a weekly injection of the weight loss drug semaglutide (the active substance in, among others). Ozempic), the rest a fake shot.

In the semaglutide group, after a year and a half, 63 percent of the patients no longer showed any accumulation of fat in their liver. The amount of scar tissue was reduced in 37 percent.

Weight loss is probably the important explanation, says Janssen, who was not involved in the study. The group that received semaglutide lost an average of 11 percent. As a result, patients were also better able to keep their blood sugar in balance. This has contributed to the effect, because it reduces liver inflammation, says Janssen. The side effects were limited to nausea and diarrhoea.

The research will continue for more than three years; Janssen expects the health effects to increase even more. Fatty liver disease is easy to tackle by losing weight, he says, but it takes more time to make scar tissue disappear.

Without fat, no scar tissue

The fact that such a large group of patients had had their fatty tissue disappeared after just a year and a half offers hope, he says: after all, without fat accumulation in the liver, scar tissue will not form. To find out whether the drug can prevent liver cancer and transplants, patients need to be monitored even longer.

Remarkably, the placebo group also fared a lot better. For example, one third of the patients who received a fake shot got rid of fatty liver disease. “We see that more often,” says Janssen: “When patients participate in a study, they will live healthier lives.”

The weight loss drugs, which mimic the intestinal hormone GLP-1, are gradually becoming all-rounders: at the beginning of this year, it became clear that users of the drugs are less at risk of 42 diseases. So far, they have been reimbursed for a small group of patients in the Netherlands.

What does this mean for you?

The results of this study once again underline how big the impact of obesity is on various health problems, including fatty liver disease. Bee Goodweigh we combine medication such as semaglutide with online lifestyle coaching and monitoring, precisely to make these broad health gains possible. These studies confirm that tackling obesity is more than just losing weight: it's investing in overall health.