A Meta-Analysis of Randomized Trials for the Treatment of Nonalcoholic Fatty Liver Disease

• DOI: 10.1002/hep.23623
• Publication Date: 2010-03-01T20:26:28Z
• Authors: Giovanni Musso; Roberto Gambino; Maurizio Cassader; Gianfranco Pagano
• Keywords: Steatosis; Pioglitazone

Nonalcoholic fatty liver disease (NAFLD) encompasses a histological spectrum ranging from simple steatosis to nonalcoholic steatohepatitis (NASH). NAFLD carries higher risk of cardio-metabolic and liver-related complications, the latter being confined NASH demanding specific treatment. We assessed efficacy proposed treatments for NAFLD/NASH by reviewing reports randomized controlled trials (RCTs) on online databases national international meeting abstracts through January 2010. Primary outcome measure was improvement; secondary biochemical improvement in radiological also evaluated. Two reviewers extracted articles using predefined quality indicators, independently duplicate. Main outcomes were pooled random-effects or fixed-effects models. Publication bias funnel plots. Forty-nine RCTs (30 NASH) included: 23 (22 NASH, 1 NAFLD) had post-treatment histology. Most small did not exceed 1-year duration. Weight loss, thiazolidinediones (especially pioglitazone), antioxidants most extensively loss safe dose-dependently improved activity but more than 50% patients failed achieve target weight loss. Thiazolidinediones inflammation yielded significant gain. with conflicting results heterogeneous respect type dose drug, duration, implementation lifestyle intervention. Among other agents, pentoxifylline, telmisartan L-carnitine histology at least RCT NASH; polyunsaturated acid (PUFA) ameliorated markers NAFLD. Other approaches negative results. Conclusion: Well-designed adequate size endpoints, are needed assess long-term safety patient-oriented clinical outcomes. Hepatology 2010