Efficacy of orlistat in non-alcoholic fatty liver disease: A systematic review and meta-analysis

Abstract

In the present meta-analysis, the efficacy and safety of orlistat in the treatment of non-alcoholic fatty liver (NAFLD) and non-alcoholic steatohepatitis (NASH) were evaluated. PubMed, Embase, the Cochrane Library, Web of Science, and Wan Fang data were searched for controlled trials of orlistat in patients with NAFLD or NASH, published before August 2017. Three randomized controlled trials and four single-arm trials were included. The involved participants with NAFLD or NASH (330 patients) were analyzed for clinical outcomes including alteration in hepatic histological variables and biomarkers of liver function. Improvements were observed in levels of alanine aminotransferase [standard mean difference (SMD)=-1.41; P=0.01], aspartate aminotransferase (SMD=-2.06; P=0.0005), γ-glutamyl transpeptidase (SMD=-1.91; P=0.05), glucose [mean difference (MD)=-0.51; P=0.01], triglycerides (MD=-0.93; P=0.01), homeostasis model assessment of insulin resistance index (MD=-1.05; P=0.04) and body mass index (MD=-1.97; P=0.02), but not in liver fibrosis score (SMD=-0.14; P=0.71). On sub-analyses of the different patient groups, no significant differences were observed in patients with NASH. Taken together, these findings demonstrate that orlistat could serve as a therapeutic drug to improve biochemical indicators of liver damage, but not as first-choice drug for the management of NAFLD or NASH; thus suggesting a novel palliative drug only for the treatment of NAFLD.

Keywords: meta-analysis; non-alcoholic fatty liver disease; non-alcoholic steatohepatitis; orlistat.

Figure 1.

Flowchart of the literature search and study selection process.

Figure 2.

Summary of risk of bias assessments for the three randomized controlled trials included in the meta-analysis.

Figure 3.

Forest plots illustrating improvement in biochemical and liver histological variables following treatment with orlistat. (A) Alanine aminotransferase; (B) aspartate aminotransferase; (C) γ-glutamyl transpeptidase; and (D) fibrosis score. NAFLD, non-alcoholic fatty liver; NASH, non-alcoholic steatohepatitis; SD, standard deviation; 95% CI, 95% confidence interval; IV, independent variable.

Figure 4.

Forest plots illustrating improvement in biochemical and anthropometric variables. (A) Fasting glucose; (B) triglycerides; (C) homeostasis model assessment of insulin resistance; and (D) body mass index. NAFLD, non-alcoholic fatty liver; NASH, non-alcoholic steatohepatitis; SD, standard deviation; 95% CI, 95% confidence interval; IV, independent variable.