Comparative efficacy of glucagon-like peptide 1 (GLP-1) receptor agonists, pioglitazone and vitamin E for liver histology among patients with nonalcoholic fatty liver disease: systematic review and pilot network meta-analysis of randomized controlled trials

ABSTRACT

Introduction

There is no conclusive evidence comparing the efficacy of glucagon-like peptide 1 (GLP-1) receptor agonists to the other guidelines recommended pharmacotherapy for nonalcoholic fatty liver disease (NAFLD). Therefore, we aim to compare the effects of GLP-1 receptor agonists, pioglitazone and vitamin E in patients with NAFLD.

Methods

We searched PubMed, Embase, Web of Science and Cochrane Library up to 11 April 2022. Randomized clinical trials (RCTs) comparing GLP-1 receptor agonists, pioglitazone and vitamin E against placebo or other active controls in patients with NAFLD were included.

Results

Nine RCTs including 1482 patients proved eligible. GLP-1 receptor agonists ranked first in steatosis, ballooning necrosis, γ-glutamyl transferase, body weight, body mass index, and triglycerides. Administration of GLP-1 receptor agonists, as compared with placebo, was associated with improvement in liver histology [steatosis (OR = 4.11, 95% CI: 2.83, 5.96), ballooning necrosis (OR = 3.07, 95% CI: 2.14, 4.41), lobular inflammation (OR = 1.86, 95% CI: 1.29, 2.68), fibrosis (OR = 1.52, 95% CI: 1.06, 2.20)].

Conclusions

GLP-1 receptor agonists were as effective as pioglitazone and vitamin E for liver histology among patients with NAFLD. GLP-1 receptor agonists might be considered as an alternative or complementary treatment in the future clinical practice.

KEYWORDS:

• Nonalcoholic fatty liver disease
• GLP-1 receptor agonists
• pioglitazone
• vitamin E
• liver histology
• network meta-analysis

Declaration of interests

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer Disclosures

Peer reviewers of this manuscript have no relevant financial or other relationships to disclose.

Author contributions

Y Gu, L Sun, and J Shi conceived the study. Y Gu and Y He designed the search strategy. L Yang, C Deng, T Kong, and R Zhou performed the literature search. C Deng, L Yang, Y Gu, T Kong, R Zhou, and Y Chen screened studies for eligibility. R Zhou and T Kong assessed the risk of bias. Y Gu, Y He, L Yang, C Deng, and Y Chen performed data extraction. Y Gu, L Sun, and W Zhang interpreted the data analysis. Y Gu, Y He, and L Sun wrote the first draft of the manuscript. All other authors revised the manuscript. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/17474124.2023.2172397

Additional information

Funding

The authors were supported by grants from the Zhejiang Provincial Basic Public Welfare Research Program (No. GF20H030035).