Low-Dose Aspirin in MASLD: Preliminary Data on a Thrifty Option

For an early stage of hepatic steatosis called MASLD, JAMA has just published results from an intriguing study. It is a small RCT showing that low-dose aspirin can significantly reduce fat in the liver of persons with MASLD and without cirrhosis.

MASLD is a new acronym for metabolic dysfunction-associated steatotic liver disease. You might know it as NAFLD or non-alcoholic fatty liver disease. In simple terms it is liver disease that results from fat building up in this vital organ, with inflammation that often leads to progressive damage. The damage can bring liver failure, cancer, and death. Serious stuff.

An Inexpensive Option

FDA has just approved a pricey new drug (resmitirom, $50,000 per year) that works quite well in more advanced forms of this disease – when MASLD has progressed to MASH. MASH is the acronym for metabolic associated steatohepatitis. At that stage, inflammation is starting to do real damage to the liver.

The idea of a simple, inexpensive drug like aspirin interrupting this disease at an early stage is very appealing. Low-dose aspirin costs only about two cents per day.

Fascinating Preliminary Results

To be clear, these results, though fascinating, are quite preliminary. This was a study of 80 persons randomly assigned to receive daily low-dose aspirin (81 mg) or a placebo for six months. They all had MASLD, but no cirrhosis. Some of them did have significant fibrosis at the start of the study.

At the end of the study, the absolute amount of liver fat had gone down by an average of seven percent in the patients receiving aspirin. In the placebo group, it had gone up by four percent.

These are good results, pointing to the possibility that aspirin therapy might offer important benefits. On low-dose aspirin, 42.5% of these patients had reductions in liver fat of 30% or more. This degree of improvement is a “meaningful treatment effect,” according to the study authors.

So the possibility of a simple, inexpensive therapy like low-dose aspirin to slow down MASLD is definitely something to watch. A confirmatory study and data on longer-term outcomes will be quite important.

Click here for the study and here for further reporting.

Bayer Aspirina Advertisement, photograph by Lameiro, licensed under CC BY-SA 4.0

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March 21, 2024