Low-dose aspirin ‘significantly’ reduced hepatic fat in MASLD by more than 10% vs. placebo
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Key takeaways:
- The mean absolute change in hepatic fat content was –6.6% in the aspirin group and 3.6% in the placebo group, a difference of –10.2%.
- Aspirin also reduced absolute and relative hepatic fat content.
Daily low-dose aspirin “significantly reduced” hepatic fat quantity at 6 months compared with placebo among patients with metabolic dysfunction-associated steatotic liver disease, according to preliminary trial results published in JAMA.
“Aspirin may represent a promising and low-cost strategy for treating MASLD and preventing progression to fibrosis, cirrhosis and hepatocellular carcinoma,” Tracey G. Simon, MD, MPH, a hepatologist at Massachusetts General Hospital, and colleagues wrote. “Observational studies in patients with MASLD demonstrated that aspirin use was associated with lower rates of disease progression to advanced fibrosis, hepatocellular carcinoma and liver-related mortality.”
However, with previous study limitations, “the therapeutic effects of aspirin for treating MASLD remain unclear,” they added.
In a phase 2, randomized, double-blind, placebo-controlled trial, Simon and colleagues investigated the effect of low-dose aspirin on reducing liver fat content among 80 adult patients (mean age, 48 years; 55% women; mean BMI, 33.7) with established MASLD, who received once-daily aspirin 81 mg (n = 40) or matching placebo (n = 40) for 6 months. The mean hepatic fat fraction among participants was 35.2%.
The primary studied outcome was mean absolute change in hepatic fat content, measured by proton magnetic resonance spectroscopy. Secondary endpoints included mean percentage change in hepatic fat content, the proportion of patients who achieved at least 30% reduction, and mean absolute and relative reductions in fat content, measured by MRI-proton density fat fraction (MRI-PDFF).
According to study results, the mean absolute change in hepatic fat content was “significantly reduced” at 6 months among those given aspirin (–6.6%; 95% CI, –11.9 to –1.3) vs. placebo (3.6%; 95% CI, –1.7 to 8.9), with a mean difference of –10.2% (95% CI, –27.7 to –2.6).
Aspirin also significantly reduced relative hepatic fat content compared with placebo (–8.8 vs. 30 percentage points; mean difference = –38.8 percentage points; 95% CI, –66.7 to –10.8) and increased the proportion of those with at least 30% relative reduction in hepatic fat (42.5% vs. 12.5%; mean difference = 30%; 95% CI, 11.6-48.4).
Moreover, aspirin reduced both absolute (–2.7% vs. 0.9%; mean difference = –3.7%; 95% CI, –6.1 to –1.2) and relative hepatic fat content (–11.7 vs. 15.7 percentage points; mean difference = –27.3 percentage points; 95% CI, –45.2 to –9.4) when measured by MRI-PDFF.
Researchers reported adverse events among 32.5% of patients in each group, the most common of which were upper respiratory tract infections and arthralgias.
“In a preliminary randomized clinical trial of patients with MASLD, 6 months of daily low-dose aspirin significantly reduced hepatic fat quantity compared with placebo,” Simon and colleagues wrote. “Further study in a larger sample size is necessary to confirm these findings.”
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