Meta-Analysis
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Sep 15, 2021; 12(9): 1576-1586
Published online Sep 15, 2021. doi: 10.4239/wjd.v12.i9.1576
Effectiveness of drug interventions in nonalcoholic fatty liver disease: A network meta-analysis
Yi-Zhou Huang, Gang-Yi Yang, Cong Wang, Xing-Yu Chen, Li-Li Zhang
Yi-Zhou Huang, Gang-Yi Yang, Cong Wang, Xing-Yu Chen, Li-Li Zhang, Department of Endocrinology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing 404100, China
Author contributions: Huang YZ and Zhang LL designed this study; Chen XY, Wang C and Yang GY contributed to the assessment of available studies; Huang YZ and Yang GY contributed to the writing of the manuscript and helpful discussion; Zhang LL is the person who takes full responsibility for the work as a whole, including (if applicable) access to data and the decision to submit and publish the manuscript.
Supported by National Natural Science Foundation of China, No. 81300702; and Natural Science Foundation Project of Chongqing CSTC, No. cstc2018jcyjAXO210.
Conflict-of-interest statement: All authors declare that they have no competing interests.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2020 Checklist, and the manuscript was prepared and revised according to the PRISMA 2020 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Li-Li Zhang, MD, PhD, Associate Professor, Doctor, Postdoc, Research Fellow, Department of Endocrinology, The Second Affiliated Hospital, Chongqing Medical University, No. 74 Linjiang Road, Yuzhong District, Chongqing 404100, China. zhanglili.jl@foxmail.com
Received: May 6, 2021
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
Processing time: 123 Days and 16.8 Hours
ARTICLE HIGHLIGHTS
Research background

Nonalcoholic fatty liver disease (NAFLD) is becoming a major chronic liver disorder worldwide. Patients with NAFLD usually experience metabolic disorder complications, including type 2 diabetes mellitus, hyperlipidemia and metabolic syndrome. However, there are no established pharmacotherapies for NAFLD.

Research motivation

The use of antidiabetic drugs, including thiazolidinediones (TZDs), metformin, glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium glucose cotransporter-2 inhibitors (SGLT2), has emerged as a major therapeutic strategy to treat patients with NAFLD. However, it is difficult for clinicians to decide which intervention is best for treating patients with NAFLD due to an absence of comprehensive comparisons among treatments.

Research objectives

In this study, we compared the effectiveness of different treatments for NAFLD. The results provide new evidence that can guide the development of clinical guidelines and thus help clinicians make individualized decisions in clinical practice.

Research methods

The Cochrane Risk of Bias tool was used to assess the risk of bias of the included studies. Data analysis was performed by Stata 14.0 (Corporation LLC, College Station, United States) and R (X64 3.6.3 version) and included inconsistency modeling, the “node-splitting” technique, Begg’s test and the construction of plots of the surface under the cumulative ranking curve.

Research results

GLP-1RAs had a great advantage over other treatments in the improvement of liver enzymes and hepatic fat content (HFC), and promising effectiveness was observed with TZDs with regard to the NAFLD activity score (NAS) set. However, no ranking of SGLT2 was possible for the NAS set due to insufficient research. In addition, the side effects of these drugs were not analyzed in this study.

Research conclusions

GLP-1RAs are the optimum therapeutic approach to improve HFC, abnormally elevated liver enzymes and overweight, while TZDs are the most promising intervention to ameliorate liver inflammation.

Research perspectives

Large multicenter prospective randomized trials with liver biopsy data regarding new classes of glucose-lowering drugs are needed to obtain robust data and confirm our results.