Comparison of effectiveness between phentermine/topiramate and liraglutide in obese patients with nonalcoholic fatty liver disease

Abstract Anti-obesity drugs improve hepatic inflammation in patients with nonalcoholic fatty liver disease (NAFLD). We aimed to compare the effects of phentermine/topiramate and liraglutide in obese NAFLD patients. This retrospective study included 411 obese NAFLD patients (body mass index [BMI] > 25 and detection of fatty liver on ultrasound) who received phentermine/topiramate (n = 303) or liraglutide (n = 108) for more than 12 months. Steatosis was assessed using the hepatic steatosis index (HSI) and controlled attenuation parameter (CAP). Fibrosis was assessed using the fibrosis index based on four factors (FIB-4), the NAFLD fibrosis score (NFS), and liver stiffness (LS). Improvements in steatosis and fibrosis were defined as ≥ 5% decreases in CAP and LS values, respectively, at 12 months compared with baseline values. Values for baseline mean body weight (phentermine/topiramate vs. liraglutide, 82.3 vs. 81.2 kg) and BMI (30.1 vs. 29.8 kg/m2) were similar between the two groups. Both groups showed significant reductions in steatosis (phentermine/topiramate: CAP, 319→290 dB/m; HSI, 40.6→37.0; liraglutide: CAP, 306→286 dB/m; HSI, 40.3→39.3,all p < 0.001) and fibrosis (phentermine/topiramate: NFS, − 2.5→−2.6; LS, 6.7→5.3kpa; liraglutide: NFS, − 2.4→−2.6, LS, 6.0→5.3kpa,all p < 0.05) after 12 months of treatment compared with baseline values. The Phentermine/topiramate group showed significantly greater weight loss and steatosis reduction than the liraglutide group (Δweight, − 7.5 vs. −4.5 kg, p = 0.001; ΔCAP: −29 vs. −8 dB/m,p < 0.001). Phentermine/topiramate treatment was an independent predictor of steatosis improvemement (odds ratio, 3.817;95% confidence interval,1.618–9.006;p = 0.002). Phentermine/topiramate or liraglutide treatment significantly ameliorated liver steatosis and fibrosis, however, phentermine/topiramate treatment resulted in better steatosis improvement.