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Nonalcoholic steatohepatitis (NASH) has been recognized increasingly as a cause of clinically important liver disease (Journal Watch Nov 7 2006). Because NASH is associated with insulin resistance, drugs that reduce insulin resistance have been proposed as treatments.
In a partially industry-supported trial from San Antonio, 55 patients with biopsy-confirmed NASH, and with either impaired glucose tolerance or type 2 diabetes, were randomized to receive pioglitazone (a thiazolidinedione that reduces insulin resistance) or placebo. Because patients were generally obese, they were also instructed about a weight-reduction diet. After 6 months of treatment, pioglitazone recipients had significant reductions in serum transaminase levels and hepati…