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Abstract Details
Statin liver safety in non-alcoholic fatty liver disease: A systematic review and metanalysis
Br J Clin Pharmacol. 2021 Jun 16. doi: 10.1111/bcp.14943. Online ahead of print.
Daniele Pastori1, Arianna Pani2, Arianna Di Rocco3, Danilo Menichelli1, Gianluca Gazzaniga2, Alessio Farcomeni4, Laura D'Erasmo5, Francesco Angelico3, Maria Del Ben1, Francesco Baratta1
Author information
1Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Italy.
2Clinical Pharmacology Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
3Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy.
4Department of Economics and Finance, University of Rome Tor Vergata, Rome, Italy.
5Department of Translational and Precision Medicine, Sapienza University of Rome, Italy.
Abstract
Aims: Statin liver safety in non-alcoholic fatty liver disease (NAFLD) patients is not well defined. We analysed differences in liver function tests, including alanine transaminase aminotransferase (ALT), aspartate transaminase (AST) and gamma-glutamyl transpeptidase (GGT) in NAFLD patients treated or not treated with statins.
Methods: We performed a systematic review of MEDLINE via PubMed and EMBASE databases and metanalysis of clinical studies investigating levels of ALT, AST and GGT in NAFLD according to statin treatment. Mean difference (MD) and percentage MD were calculated between the two groups.
Results: We included 22 studies with 2345 NAFLD patients. Overall, 16 were before-after interventional, five were cross-sectional and one was combined cross-sectional/interventional study. In all interventional studies, except one, patients had raised ALT, AST and GGT at baseline. Interventional studies showed reduced ALT values with an MD reduction of -27.2 U/L (95% CI -35.25/-19.15) and a percentage MD reduction of -35.41% (95% CI -44.78/-26.04). Also, AST values were reduced after statin treatment in interventional studies with an MD of -18.82 U/L (95% CI -25.63/-12.02) (percentage -31.78%, 95% CI -41.45/-22.11). Similarly, GGT levels were reduced after statin treatment with an MD of -19.93 U/L (95% CI -27.10/-12.77) (percentage -25.57%, 95% CI -35.18/-15.97). Cross-sectional studies showed no difference in AST and GGT values between patients treated with and without statins.
Conclusion: In interventional studies, ALT, AST and GGT were reduced after statin treatment with a percentage mean difference of -35.41%, -31.78% and -25.57%, respectively, while observational studies showed a null effect, suggesting liver safety of statins in NAFLD patients.