Published online Sep 15, 2021. doi: 10.4239/wjd.v12.i9.1576
Peer-review started: May 6, 2021
First decision: July 3, 2021
Revised: July 9, 2021
Accepted: August 12, 2021
Article in press: August 12, 2021
Published online: September 15, 2021
Nonalcoholic fatty liver disease (NAFLD) is a major chronic liver disorder worldwide, and there is no established treatment for this disease. We conducted a network meta-analysis (NMA) to compare existing treatments, which include four classes of antidiabetic drugs, and examined the optimum treatments for NAFLD.
To compare the effectiveness of different treatments for NAFLD.
An NMA was conducted using Stata 14.0 (Corporation LLC, College Station, United States) and R (X64 3.6.3 version) in this study. Eligible randomized controlled trials (RCTs) were searched in the PubMed, Cochrane Library, Embase, Medline and Web of Science databases from database inception to April 2021. Two researchers independently screened the available studies in strict accordance with inclusion and exclusion criteria. The Cochrane Risk of Bias tool was used to evaluate the risk of bias of the included studies. The variables with and without dimensional differences were calculated as the standardized mean difference and weighted mean difference, respectively. An inconsistency model and “node-splitting” technique were used to test for inconsistency. Funnel plots were used to evaluate publication bias.
Twenty-two eligible RCTs involving 1377 participants were eventually included in our analysis. Data were pooled using a random-effects model. Our NMA results revealed that glucagon-like peptide-1 receptor agonists (GLP-1RAs) were the most effective treatment, yielding improvements in hepatic fat content (HFC), alanine aminotransferase (ALT), aspartate aminotransferase (AST), serum γ-glutamyl transferase (GGT) and body weight [surface under the cumulative ranking curve (SUCRA) = 99.6%, 92.6%, 82.8%, 92.3% and 99.6%, respectively], while thiazolidinediones (TZDs) were the best intervention for reducing the NAFLD activity score (NAS; SUCRA = 98.9%). In addition, moderate performance was observed for the sodium glucose cotransporter-2 inhibitors groups (SUCRA = 25.1%, 66.2%, 63.5%, 58.2% and 71.9% for HFC, ALT, AST, GGT and body weight, respectively). However, metformin performed poorly according to most indicators (SUCRA = 54.5%, 0.3%, 19.5%, 33.7%, 57.7% and 44.3% for HFC, NAS, ALT, AST, GGT and body weight, respectively).
GLP-1RAs may be the optimum choice for most patients with NAFLD. However, TZDs are considered the most effective therapies in NAFLD patients with histological disease activity.
Core Tip: We performed a network meta-analysis and compared the effectiveness of different treatments for nonalcoholic fatty liver disease. In this study, glucagon-like peptide-1 receptor agonists and thiazolidinediones were revealed to be the best interventions for nonalcoholic fatty liver disease, and these findings could help clinicians make significant decisions in clinical practice. Furthermore, we address the possibility of using sodium glucose cotransporter-2 inhibitors in nonalcoholic fatty liver disease; however, trials with larger sample sizes are needed to obtain high-quality evidence.