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Comparative Study
. 2023 Jul;29(3):693-704.
doi: 10.3350/cmh.2022.0330. Epub 2023 Mar 9.

Comparison of glucagon-like peptide-1 receptor agonists and thiazolidinediones on treating nonalcoholic fatty liver disease: A network meta-analysis

Min Jeong Park  1 , Hayeon Kim  2 , Myeong Gyu Kim  3 , Kyungim Kim  2   4
Affiliations
Comparative Study

Comparison of glucagon-like peptide-1 receptor agonists and thiazolidinediones on treating nonalcoholic fatty liver disease: A network meta-analysis

Min Jeong Park et al. Clin Mol Hepatol. 2023 Jul.

Abstract

Background/aims: Previous studies have revealed that glucagon-like peptide-1 receptor agonist (GLP-1RA) and thiazolidinedione (TZD) can improve nonalcoholic fatty liver disease (NAFLD) or nonalcoholic steatohepatitis (NASH). However, comprehensive research comparing the effects of GLP-1RA and TZD is limited. Thus, this study aimed to compare the effects of GLP-1RA and TZD on NAFLD or NASH through a network meta-analysis.

Methods: The PubMed, Embase, Web of Science, and Scopus databases were searched for randomized controlled trials (RCTs) that explored the efficacy of GLP-1RAs or TZDs in adult patients with NAFLD or NASH. The outcomes were liver biopsy-based (NAFLD activity score [NAS], fibrosis stage, and NASH resolution), noninvasive technique-based (liver fat content on proton magnetic resonance spectroscopy [1H-MRS] and controlled attenuation parameter [CAP]), biological, and anthropometric indicators. A random effects model was used to calculate the mean difference (MD) and relative risk with 95% confidence interval (CI).

Results: Twenty-five RCTs with 2,237 overweight or obese patients were included. GLP-1RA was significantly superior in reducing liver fat content evaluated using 1H-MRS (MD -2.42, 95% CI -3.84 to -1.00), body mass index (MD -1.60, 95% CI -2.41 to -0.80), and waist circumference (MD -4.89, 95% CI -8.17 to -1.61) than TZD. In liver biopsy-based evaluation and liver fat content assessment using CAP, GLP-1RA tended to surpass TZD, albeit not significantly. Sensitivity analysis showed consistent results with the main results.

Conclusion: Compared with TZD, GLP-1RA had better effects on liver fat content, body mass index, and waist circumference in overweight or obese patients with NAFLD or NASH.

Keywords: Glucagon-like peptide-1 receptor agonist; Network meta-analysis; Nonalcoholic fatty liver disease; Nonalcoholic steatohepatitis; Thiazolidinediones.

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Conflict of interest statement

Conflicts of Interest

The authors have no conflictsto disclose.

Figures

Figure 1.
Figure 1.
Article selection flow diagram. RCT, randomized controlled trial.
Figure 2.
Figure 2.
Forest plot of network meta-analysis of liver biopsy-based outcomes: (A) NAS, (B) Fibrosisstage, and (C) NASH resolution. NAS, nonalcoholic fatty liver activity score; NASH, nonalcoholic steatohepatitis; MD, mean difference; CI, confidence interval; RR, relative risk; GLP-1RA, glucagon-like peptide-1 receptor agonist; TZD, thiazolidinedione. *Only NASH resolution is presented asrelative risk with 95% CI, which favors greater value in thisstudy.
Figure 3.
Figure 3.
Forest plot of network meta-analysis of noninvasive technique-based outcomes: (A) liver fat content by 1H-MRS and (B) liver fat content by CAP. 1H-MRS, proton magnetic resonance spectroscopy; CAP, controlled attenuation parameter; MD, mean difference; CI, confidence interval; GLP-1RA, glucagon-like peptide-1 receptor agonist; TZD, thiazolidinedione.
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References

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