CASE REPORT article

Front. Endocrinol.

Sec. Clinical Diabetes

Volume 16 - 2025 | doi: 10.3389/fendo.2025.1501984

This article is part of the Research TopicMetabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) - Pathogenesis, Prevention and TreatmentView all 11 articles

Case report: Amelioration of severe metabolic dysfunction-associated steatohepatitis switching from conventional GLP-1RAs to tirzepatide

Provisionally accepted
Yuki  OeYuki Oe1,2*Takashi  OmoriTakashi Omori1Eriko  AimonoEriko Aimono2Shin  FurukawaShin Furukawa1Hirohiko  KitakawaHirohiko Kitakawa1Masatoshi  TatenoMasatoshi Tateno1Kiyoshi  SakaiKiyoshi Sakai1
  • 1Kushiro Red-Cross Hospital, Kushiro, Japan
  • 2Hokkaido University, Sapporo, Hokkaidō, Japan

The final, formatted version of the article will be published soon.

Metabolic dysfunction-associated steatohepatitis (MASH) contains cardiometabolic risk factors, such as obesity and type 2 diabetes, and has been reported potential higher risks of mortality than conventional steatotic liver diseases. Liver fibrosis develops and can progress to cirrhosis and hepatocellular carcinoma. Although some antidiabetic agents have been reported to ameliorate the condition, no specific medical treatment has been developed to date. Tirzepatide is a dual glucosedependent insulinotropic polypeptide and glucagon-like peptide-1 (GLP-1) receptor agonist that has shown efficacy against MASH in some clinical trials. However, these subjects were limited to those with mild-to-moderate fibrosis and their history of treatment was often unclear. Here, we report the case of a 50-year-old man with a 16-year history of diabetes. He demonstrated poor control of his diabetes with elevated liver enzyme. Liver biopsy was performed and he was diagnosed with "Steatohepatitis". Liraglutide was administered for 3 years, but his liver function and glycemic control deteriorated gradually and a second liver biopsy was performed in 2023. The histologic finding was "Cirrhosis" and liraglutide was switched to tirzepatide. Over 6 months of administration of tirzepatide, the patient's glycated hemoglobin and elevated liver enzyme improved. A third biopsy was performed, which showed a marked improvement in histology, with the amelioration of liver fibrosis. A diagnosis of "Steatotic liver disease" was made. Although some previous studies had demonstrated an amelioration of liver fibrosis and an improvement in the prognosis of patients following GLP-1 receptor agonists (GLP-1RAs) treatment, effective medications for patients with severe fibrosis or who are refractory to treatment with GLP-1RAs has not been identified to date. We reported a case with severe MASH who had ameliorated by switching from conventional GLP-1RAs to tirzepatide.

Keywords: Glucose-dependent insulinotropic polypeptide, Glucagon-like peptide 1 receptor, type 2 diabetes, metabolic dysfunction-associated steatohepatitis, Obesity

Received: 26 Sep 2024; Accepted: 25 Apr 2025.

Copyright: © 2025 Oe, Omori, Aimono, Furukawa, Kitakawa, Tateno and Sakai. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Yuki Oe, Kushiro Red-Cross Hospital, Kushiro, Japan

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