GLP-1RA was significantly superior in reducing liver fat content by 2.42 units compared to TZD in a meta-analysis of 2,237 patients.
GLP-1RA also led to a greater reduction in body mass index by 1.60 units and waist circumference by 4.89 units compared to TZD.
In liver biopsy evaluations, GLP-1RA showed a tendency to outperform TZD, though the difference was not statistically significant.
Both GLP-1RA and TZD were analyzed for their effects on (NAFLD) and (NASH).
Sensitivity analysis confirmed the robustness of the findings regarding GLP-1RA's advantages.
Simplified
BACKGROUND/AIMS: Previous studies have revealed that glucagon-like peptide-1 receptor agonist (GLP-1RA) and thiazolidinedione (TZD) can improve (NAFLD) or (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.
Key numbers
-2.42
Reduction in Liver Fat Content
Mean difference in liver fat content measured by H-MRS.
-1.60
Decrease in Body Mass Index (BMI)
Mean difference in BMI between GLP-1RA and TZD.
-4.89
Decrease in Waist Circumference
Mean difference in waist circumference between GLP-1RA and TZD.
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