Reductions in alanine aminotransferase levels with liraglutide treatment are greatest in those with raised baseline levels and are independent of weight loss: real-world outcome data from the ABCD Nationwide Liraglutide Audit

People with type 2 diabetes mellitus experience an increased prevalence of non-alcoholic fatty liver disease (NAFLD) compared with the general population and often with worse outcomes. As part of the ABCD Liraglutide Nationwide Audit Programme, we obtained and analysed data from 2009 to 2018 to assess the impact of liraglutide on alanine aminotransferase (ALT) levels as a marker of liver inflammation (often used in clinical trials as a marker of NAFLD). After excluding those with insufficient or incomplete data, we analysed the results from 1,759 patients treated in the real-world clinical setting. Our results demonstrated an overall significant decrease in median ALT (−1 U/L, 95% CI −1 to −2, p<0.001) compared with baseline, which was more pronounced in patients with elevated ALT based on gender- specific ranges (male: −4 U/L, 95% CI −3 to −6, p<0.001; female: −3 U/L, 95% CI −2 to −4, p<0.001). There was no correlation between weight loss and degree of ALT change (rho=−0.0002, p=0.41). Our data mirror outcomes from large randomised controlled trials and show that the impact of liraglutide on ALT is likely generalisable to real-world practice. Some of our data suggest that there may be a slight increase in ALT in those with normal levels at baseline, although the clinical significance of this is uncertain.