Comparison of Glucagon-Like Peptide-1 Receptor Agonists and Sodium-Glucose Cotransporter Protein-2 Inhibitors on Treating Metabolic Dysfunction-Associated Steatotic Liver Disease or Metabolic Dysfunction-Associated Steatohepatitis: Systematic Review and Network Meta-Analysis of Randomised Controlled Trials

Dec 19, 2024Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists

Comparing two diabetes drug types for treating metabolic fatty liver disease and liver inflammation

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Abstract

GLP-1 receptor agonists showed a 2.48 times greater effectiveness than placebo in resolving NASH.

Thirty-seven studies were included in the analysis of GLP-1 receptor agonists and SGLT-2 inhibitors in patients with liver disease.
Both GLP-1 receptor agonists and SGLT-2 inhibitors were more effective than placebo in reducing liver fat content and liver enzyme levels.
SGLT-2 inhibitors were more effective than GLP-1 receptor agonists in lowering alanine aminotransferase and aspartate aminotransferase levels.
GLP-1 receptor agonists and SGLT-2 inhibitors consistently ranked among the top 2 treatments for reducing body measurements in the analysis.

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OBJECTIVE: To assess glucagon-like peptide-1 receptor agonists (GLP-1 receptor agonists) and sodium-glucose cotransporter protein-2 inhibitors (SGLT-2 inhibitors) in patients with metabolic dysfunction-associated steatotic liver disease or metabolic dysfunction-associated steatohepatitis (previously known as nonalcoholic fatty liver disease [NAFLD] and nonalcoholic steatohepatitis [NASH]), we performed a systematic review and network meta-analysis of randomized controlled trials.

METHODS: The study searched Pubmed, Embase, the Cochrane Library, and Web of Science databases up to November 26, 2023. Two reviewers independently selected the studies, extracted the data, and assessed the risk of bias.

RESULTS: Thirty-seven studies were included in the analysis. GLP-1 receptor agonists were found to be more effective than placebo in resolving NASH (relative risk: 2.48, 95% CI:1.86 to 3.30). Both drugs were superior to placebo in reducing liver fat content, as well as decreasing levels of liver enzyme. Network meta-analysis indicated that SGLT-2 inhibitors were more effective than GLP-1 receptor agonists in reducing alanine aminotransferase and aspartate aminotransferase levels. According to the surface under the cumulative probability ranking curve values, GLP-1 receptor agonists and SGLT-2 inhibitors consistently ranked among the top 2 in terms of reducing anthropometric data compared to other included drugs.

CONCLUSIONS: GLP-1 receptor agonists and SGLT-2 inhibitors have significant effects on reducing liver fat content and liver enzymes in NAFLD or NASH patients compared to placebo. GLP-1 receptor agonists were found to be superior to placebo in resolving NASH. SGLT-2 inhibitors were more effective than GLP-1 receptor agonists in reducing alanine aminotransferase and aspartate aminotransferase levels.

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