Quick Summary, an older drug for diabetes has shown to be effective for Fatty liver disease. But it doesn't look like it was that effective, and pioglitazone can exacerbate or cause Heart failure symptoms in patients. UpToDate is not a fan either and states "May consider use in patients with biopsy-confirmed metabolic dysfunction associated steatohepatitis who also have type 2 diabetes mellitus; treatment may also be considered in patients with prediabetes, though risks may more closely match benefits".


In all seriousness, pioglitazone is a rarely used drug now days, we need better options for fatty liver disease. I only use pioglitazone in 1 patient with T2DM and Fatty Liver disease. . . The other patient I had in that category had Heart failure.

The 1 patient on pioglitazone is having REALLY good results on the new lower price Victoza, has lost significant weight, and will likely be able to stop the pioglitazone soon.