TY - JOUR
T1 - Pioglitazone and bariatric surgery are the most effective treatments for non-alcoholic steatohepatitis: A hierarchical network meta-analysis
AU - Panunzi, Simona
AU - Maltese, Sabina
AU - Verrastro, Ornella
AU - Labbate, Luca
AU - De Gaetano, Andrea
AU - De Gaetano, Anna Maria
AU - Pompili, Maurizio
AU - Capristo, Esmeralda
AU - Bornstein, Stefan R.
AU - Mingrone, Geltrude
PY - 2021
Y1 - 2021
N2 - Aims: To compare different treatments for non-alcoholic steatohepatitis (NASH) and to. determine an effectiveness hierarchy. Materials and Methods: We conducted 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 body mass index (BMI) decrement or reduction of homeostatic model assessment of insulin resistance (HOMA-IR) index on non-alcoholic fatty liver disease 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, a 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.
AB - Aims: To compare different treatments for non-alcoholic steatohepatitis (NASH) and to. determine an effectiveness hierarchy. Materials and Methods: We conducted 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 body mass index (BMI) decrement or reduction of homeostatic model assessment of insulin resistance (HOMA-IR) index on non-alcoholic fatty liver disease 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, a 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.
KW - bariatric surgery
KW - fatty liver disease
KW - systematic review
KW - bariatric surgery
KW - fatty liver disease
KW - systematic review
UR - http://hdl.handle.net/10807/167614
U2 - 10.1111/dom.14304
DO - 10.1111/dom.14304
M3 - Article
SN - 1462-8902
VL - 23
SP - 980
EP - 990
JO - Diabetes, Obesity and Metabolism
JF - Diabetes, Obesity and Metabolism
ER -