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In 2019, an open-label randomised trial conducted for 48 weeks, including patients with biopsy-proven MASH, demonstrated that the association between N-acetylcysteine and metformin could reduce liver disease activity in patients with MASH, testified by the improvement in ballooning and NAS [127], and in a randomised, double-blind, placebo-controlled trial conducted on 173 children affected by MASLD, metformin (−0.3 vs
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