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
Abstract
BACKGROUND

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.

AIM

To compare the effectiveness of different treatments for NAFLD.

METHODS

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.

RESULTS

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).

CONCLUSION

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.

Keywords: Antidiabetic drugs; Glucagon-like peptide-1 receptor agonists; Nonalcoholic fatty liver disease; Network meta-analysis; Thiazolidinediones

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.