Rosiglitazone for Nonalcoholic Steatohepatitis
Article Outline
Dear Sir:
In a recent issue of Gastroenterology, Ratziu et al1 reported the efficacy and safety of rosiglitazone, an insulin-sensitizing agent, in patients with nonalcoholic steatohepatitis (NASH). The study is important because it provides scientific information on this clinically relevant condition. However, we think that some points should be discussed.
First, as shown in Table 1 of the article, most of the patients with NASH are overweight or obese. In addition, an important portion of the study participants have other metabolic disturbances (high blood pressure, dyslipidemia, etc) alone or in combination. It is well known that all components that constitute the metabolic syndrome are risk factors for type 2 diabetes mellitus as well as prediabetes, namely, impaired fasting glucose and/or impaired glucose tolerance.2 Although both type 2 diabetes and impaired glucose tolerance are among the components of the metabolic syndrome,3 plasma insulin and adipokine levels differ according to the degree of glucose dysregulation.4, 5 The same is also true for hypertension or elevated blood pressure and dyslipidemia.6, 7 Second, apart from the metformin and sulfonamides, no information about the drug use of the subjects could be seen in the text. We know that circulating adipokines and measures of insulin sensitivity are easily affected by medications started for the metabolic problems mentioned above.8, 9, 10 Collectively, all these points raise several questions warranting discussion.
Therefore, we would like to ask the authors whether they can present some new results by categorizing the patients with NASH according to metabolic confounders such as type 2 diabetes, impaired glucose tolerance, blood pressure, and lipid profile. This may provide the readers clearer information regarding the relationship between adipokines and NASH.
References
- Rosiglitazone for nonalcoholic steatohepatitis: one-year results of the randomized placebo-controlled Fatty Liver Improvement with Rosiglitazone Therapy (FLIRT) Trial. Gastroenterology. 2008;135:100–110
- The National Cholesterol Education Program—Adult Treatment Panel III, International Diabetes Federation, and World Health Organization definitions of the metabolic syndrome as predictors of incident cardiovascular disease and diabetes. Diabetes Care. 2007;30:8–13
- Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation. 2005;112:2735–2752
- Plasma visfatin levels in patients with newly diagnosed and untreated type 2 diabetes mellitus and impaired glucose tolerance. Diabetes Res Clin Pract. 2007;76:24–29
- Hypoadiponectinemia is associated with impaired glucose tolerance and coronary artery disease in non-diabetic men. Circ J. 2007;71:1703–1709
- Adiponectin, but not leptin or high-sensitivity C-reactive protein, is associated with blood pressure independently of general and abdominal adiposity. Hypertens Res. 2008;31:633–640
- Plasma apelin is lower in patients with elevated LDL-cholesterol. Exp Clin Endocrinol Diabetes. 2007;115:428–432
- Effect of antihypertensive agents on plasma adiponectin levels in hypertensive patients with metabolic syndrome. Nephrology (Carlton). 2007;12:147–153
- . The effect of thiazolidinediones on adiponectin serum level: a meta-analysis. Diabetes Obes Metab. 2008;10:367–375
- The effects of pioglitazone and metformin on plasma visfatin levels in patients with treatment naive type 2 diabetes mellitus. Diabetes Res Clin Pract. 2008;82:214–218
The authors disclose no conflicts.
PII: S0016-5085(08)01852-0
doi:10.1053/j.gastro.2008.08.059
© 2008 AGA Institute. Published by Elsevier Inc. All rights reserved.
