Comparative efficacy of multiple drugs for non-alcoholic fatty liver disease: a Bayesian network meta-analysis

Nov 25, 2025European journal of medical research

Comparing how well different drugs work for non-alcoholic fatty liver disease

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Abstract

Glucagon-like peptide-1 receptor agonists (GLP-1RA) showed superior efficacy in treating patients with metabolic dysfunction-associated steatotic liver disease (MASLD) across multiple health outcomes.

  • This analysis included 26 randomized controlled trials (RCTs) with 2143 patients.
  • GLP-1RA was associated with significant weight loss, improved liver enzymes, resolution of non-alcoholic steatohepatitis (), reduced hepatic fat content, enhanced glycemic control, and better insulin resistance.
  • Sodium-glucose cotransporter protein-2 inhibitors (SGLT-2I) demonstrated moderate benefits in weight loss and reduction of liver enzyme levels compared to placebo.
  • Thiazolidinediones (TZD) provided significant histological benefits but may lead to weight gain.
  • Vitamin E was linked to improvements in liver enzyme levels and histological features.
  • Evidence supporting these findings is of moderate certainty according to the GRADE framework assessment.

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Key numbers

2143 patients
Total Patients
Included across 26 randomized controlled trials.
MD - 1.20
Weight Loss (SGLT-2I)
95% - 1.83 to - 0.71.
MD - 12.96
Liver Enzyme Reduction (ALT)
95% - 19.24 to - 6.86.

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