MASLD, formerly known as nonalcoholic fatty liver disease (NAFLD), affects up to a third of US adults. The study published in JAMA found that low-dose aspirin use improved several markers of liver health associated with inflammation and fibrosis.

Patients with MASLD without cirrhosis who took daily low-dose aspirin for 6 months achieved a 10% reduction in their liver fat content compared with those who took placebo, according to a study by Massachusetts General Hospital investigators.[1]

Aspirin’s potential

Patients with MASLD, the most common chronic liver disease, present with increased liver fat, often due to type 2 diabetes and obesity, which poses serious health risks.

However, based on the study findings, senior author Andrew T. Chan, MD, MPH, explained in a Mass General press release that “aspirin represents an attractive potential low-cost option to prevent progression to cirrhosis or liver cancer, the most feared complications of MASLD.”[2]

Aspirin has shown hepatic anti-inflammatory effects in experimental models by inhibiting cycloxygenase-2 and platelet-derived growth factor signalling. In cross-sectional studies of patients with NAFLD, aspirin was associated with a reduced prevalence of liver steatosis and measures of fibrosis.

A previous prospective study by the Mass General researchers found that daily aspirin use was associated with less severe histologic features of NAFLD and non-alcoholic steatohepatitis, along with a lower risk of progression to advanced liver fibrosis.[3]

Between August 20, 2019, and July 19, 2022, the study enrolled 80 participants with MASLD without cirrhosis. The participants’ mean age was 48 years, 55% were women, and their mean hepatic fat content was 35%, indicating moderate steatosis. They were randomised (1:1) to receive either once-daily aspirin (81 mg) or placebo for 6 months. At the final follow-up on February 23, 2023, the researchers reported that 89% of the participants completed the 6-month follow-up. 

The primary endpoint—the mean absolute change in liver fat content measured by proton magnetic resonance spectroscopy (MRS) at 6-month follow-up, was met.

The aspirin-treated patients had a 6.6% reduction in liver fat content. In contrast, the placebo group had a 3.6% increase, representing a 10.2% reduction in liver fat content with low-dose aspirin vs placebo.

Markers of liver health

The four key secondary outcomes were also met: (1) the mean change in liver fat content measured by MRS (aspirin reduced this by 38.8% vs placebo); (2) the proportion of patients achieving at least a 30% relative reduction in liver fat (aspirin increased this by 30%); and the mean absolute (3) and relative (4) reductions in hepatic fat content, both measured by MRI-PDFF (aspirin reduced these by 3.7% and 27.3%, respectively).

Lead author and principal investigator Tracey G. Simon, MD, MPH, summarised the study results in the press release: “Multiple non-invasive blood and imaging-based tests for liver fat, inflammation, and fibrosis all showed a similar direction of benefit that favoured aspirin treatment. Together, these data support the potential for aspirin to provide benefits for patients with MASLD.”

Tolerability

During the study, low-dose aspirin was found to be safe and well-tolerated, although one participant in the aspirin group experienced drug-related heartburn. Overall adverse events occurred in 32.5% of each study group. Specifically, 10% of each group experienced upper respiratory tract infections, while arthralgias occurred in 5% of the aspirin group and 7.5% of the placebo group.

The researchers recommend further study with a larger sample size to determine whether continued aspirin use can reduce the long-term health complication risk associated with MASLD.

Disclaimer: This story is contributed by Katie Robinson and is a part of our Global Content Initiative, where we feature selected stories from our Global network which we believe would be most useful and informative to our doctor members