Systematic review with network meta‐analysis: comparative efficacy of pharmacologic therapies for fibrosis improvement and resolution of NASH
Year: 2021
Type: review
Study designs: Systematic Review, Meta-Analysis
Abstract: BACKGROUND: Nonalcoholic steatohepatitis (NASH) is a common cause of chronic liver disease. There is a major need to understand the efficacy of different pharmacological agents for the treatment of NASH. AIM: To assess the relative rank-order of different pharmacological interventions in fibrosis improvement and NASH resolution. METHODS: A comprehensive search of several databases was conducted by an experienced librarian. We included randomised controlled-trials (RCTs) comparing pharmacological interventions in patients with biopsy-proven NASH. The primary outcome was ≥1 stage improvement in fibrosis. The secondary outcome was NASH resolution. RESULTS: A total of 26 RCTs with 23 interventions met the eligibility criteria. Lanifibranor and obeticholic acid had the highest probability of being ranked the most effective intervention for achieving ≥1 stage of fibrosis improvement (SUCRA 0.78) and (SUCRA 0.77), respectively. For NASH resolution, semaglutide, liraglutide and vitamin E plus pioglitazone had the highest probability of being ranked the most effective intervention for achieving NASH resolution (SUCRA 0.89), (SUCRA 0.84) and (SUCRA 0.83), respectively. Lanifibranor, obeticholic acid, pioglitazone and vitamin E were significantly better than placebo in achieving ≥1 stage of fibrosis improvement. Conversely, semaglutide, liraglutide, vitamine E plus pioglitazone, pioglitazone, lanifibranor and obeticholic acid were significantly better than placebo in achieving NASH resolution. CONCLUSION: These data provide relative rank-order efficacy of various NASH therapies in terms of their improvements in liver fibrosis and NASH resolution. Therapies that have been shown to improve NASH resolution may be combined with therapies that have an antifibrotic effect to further boost treatment response rate in future.
DOI: 10.1111/apt.16583
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: green
Funders: National Institutes of Health, National Institute on Alcohol Abuse and Alcoholism, National Heart, Lung, and Blood Institute, National Institute of Diabetes and Digestive and Kidney Diseases, National Institute of Environmental Health Sciences, National Center for Advancing Translational Sciences
Awards: A Cardiovascular-NASH disease nexus: Common Mechanisms and Treatments?, DETECTION AND MODELS OF TOXICANT EXPOSURE, Non-invasive screening of diabetics for advanced fibrosis due to NAFLD, Novel IL-23 inhibitor for the treatment of alcohol associated liver disease, Ancillary Studies of NAFLD and NASH in HIV infected Adults, QUS Technology for Diagnosis and Grading of Hepatic Steatosis in NAFLD, UC San Diego Clinical and Translational Research Institute, San Diego Digestive Diseases Research Center, Clinical Research on Nonalcoholic Fatty Liver Disease
OpenAlex ID: W3193811807