Author information
1 Division of Gastroenterology and Hepatology, William S Middleton VA Medical Center, Madison, WI, USA; Department of Medicine, William S Middleton VA Medical Center, Madison, WI, USA; University of Wisconsin, School of Medicine and Public Health, William S Middleton VA Medical Center, Madison, WI, USA. Electronic address: axs@medicine.wisc.edu.
2 Division of Gastroenterology and Hepatology, William S Middleton VA Medical Center, Madison, WI, USA; Department of Medicine, William S Middleton VA Medical Center, Madison, WI, USA.
Abstract
BACKGROUND:
Currently, there is no standardized treatment regimen for non-alcoholic steatohepatitis.
AIM:
We performed a meta-analysis of high quality randomized controlled trials that evaluated treatment response to metformin, thiazolidinediones (TZDs), and vitamin E in adult patients with non-alcoholic steatohepatitis. Outcome measures were improvement in liver histology, biochemical, and anthropometric measures.
MATERIAL AND METHODS:
Nine trials met inclusion criteria (3 with TZD, 3 with Metformin, 2 with Vitamin E and 1 with both TZD and Vitamin E.).
RESULTS:
With metformin, weighted liver histologic scores for steatosis, ballooning, and fibrosis did not demonstrate significant improvement and lobular inflammation worsened significantly (weighted mean increase 0.21, 95% CI 0.11 to 0.31, P < 0.0001). The liver histology score including steatosis (OR 3.51, 95% CI 2.14 to 5.78) and lobular inflammation (OR 2.65, 95% CI 1.69 to 4.15) improved with TZDs. Hepatic fibrosis (OR 1.58, 95% CI 0.98 to 2.54) and ballooning scores (OR 1.84, 95% CI 0.94 to 3.58) did not demonstrate significant improvement. With Vitamin E, weighted liver histologic scores for steatosis (weighted mean decrease -0.60, 95% CI -0.85 to -0.35, P < 0.0001), lobular inflammation (weighted mean decrease -0.40, 95% CI -0.61 to -0.20, P = 0.0001) and ballooning (weighted mean decrease -0.30, 95% CI -0.54 to -0.07, P = 0.01) demonstrated significant improvement compared to placebo. Fibrosis did not significantly change.
CONCLUSION:
In patients with NASH, TZDs and Vitamin E improve liver histologic scores but metformin does not. Insulin resistance also improves with both TZDs and metformin. Fibrosis does not improve with any of the agents.