The summaries are free for public
use. The Chronic Liver Disease
Foundation will continue to add and
archive summaries of articles deemed
relevant to CLDF by the Board of
Trustees and its Advisors.
Abstract Details
Pioglitazone and bariatric surgery are the most effective treatments for non-alcoholic steato-hepatitis: a hierarchical network meta-analysis
Diabetes Obes Metab. 2020 Dec 23. doi: 10.1111/dom.14304. Online ahead of print.
Simona Panunzi1, Sabina Maltese2, Ornella Verrastro34, Luca Labbate2, Andrea De Gaetano1, Maurizio Pompili34, Esmeralda Capristo34, Stefan R Bornstein56, Geltrude Mingrone346
Author information
1CNR-IASI, Laboratorio di Biomatematica, Consiglio Nazionale delle Ricerche, Istituto di Analisi dei Sistemi ed Informatica, Rome, Italy.
2CNR-IRIB, Consiglio Nazionale delle Ricerche, Istituto per la Ricerca e l'Innovazione Biomedica Palermo, Italy.
3Fondazione Policlinico Universitario A. Gemelli IRCCS.
4Università Cattolica del Sacro Cuore Rome, Italy.
5Department of Medicine III, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany.
6Division of Diabetes & Nutritional Sciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom.
Abstract
Aims: To compare different treatments for Non-Alcoholic Steato-Hepatitis (NASH) and to determine an effectiveness hierarchy.
Materials-and-methods: This is a systematic review and Bayesian Network Meta-Analysis including randomized-controlled trials or prospective trials with at least 6 months follow-up and histologically-proven NASH in adult participants. Monte Carlo simulations were performed, each generating 10,000 data points, and results are reported as medians and 95% Credibility Intervals (CrIs). A meta-regression was conducted to find the effects of BMI decrement or reduction of HOMA-IR on NAFLD Activity Score (NAS) change.
Results: The review identified 48 eligible trials comprising 2356 adults (55.6% men). Data were pooled using a random-effects model. The most effective treatments in terms of NAS reduction per semester were Pioglitazone and Roux-en-Y Gastric-ByPass (RYGB) (-1.50; 95% CrI: -2.08, -1.00 for Pioglitazione and -1.00; 95% CrI: -1.70, -0.32 for RYGB). Pioglitazone was also the best therapy for steatosis and lobular inflammation reduction; RYGB was the best treatment for hepatocellular ballooning reduction, whereas antioxidants appeared to be best for fibrosis improvement. For each 1% decrement in BMI, NAS was reduced by 1.3% (β=1.28%, P=0.01). Conversely, 1% reduction of HOMA-IR index reduced NAS by 0.3% (β=0.31%,P<0.001). Treatments that were regarded as promising, such as Elafibranor, Simtuzumab, Selonsertib, Cenicriviroc, Obeticholic acid and Liraglutide did not reduce either NAS or liver fibrosis significantly.
Conclusions: Pioglitazione and RYGB are the most effective therapies for NASH. Antioxidants may be effective in reducing liver fibrosis. Weight loss and improvement of hepatic insulin resistance are promising approaches in the treatment of NASH.