Comparison of sodium-glucose cotransporter-2 inhibitors and thiazolidinediones for management of non-alcoholic fatty liver disease: A systematic review and meta-analysis.

Autor: Hameed I; Department of Internal Medicine, Dow University of Health Sciences, Karachi 74200, Pakistan., Hayat J; Department of Internal Medicine, Dow University of Health Sciences, Karachi 74200, Pakistan. Electronic address: jhayat0121@gmail.com., Marsia S; Department of Internal Medicine, Dow University of Health Sciences, Karachi 74200, Pakistan., Samad SA; Department of General Surgery, Dow University of Health Sciences, Karachi, Pakistan., Khan R; Department of Anesthesia, The Aga Khan University Hospital, Karachi, Pakistan., Siddiqui OM; Department of Internal Medicine, Dow University of Health Sciences, Karachi 74200, Pakistan., Khan MO; Department of Internal Medicine, Dow University of Health Sciences, Karachi 74200, Pakistan., Malik S; Department of Internal Medicine, Dow University of Health Sciences, Karachi 74200, Pakistan., Fatima K; Department of Internal Medicine, Dow University of Health Sciences, Karachi 74200, Pakistan., Fudim M; Division of Cardiology, Duke University Health System, Durham, NC, United States of America; Duke Clinical Research Institute, 200 Morris Street, Durham, NC 27701, United States of America., Krasuski RA; Division of Cardiology, Duke University Health System, Durham, NC, United States of America.
Jazyk: angličtina
Zdroj: Clinics and research in hepatology and gastroenterology [Clin Res Hepatol Gastroenterol] 2023 May; Vol. 47 (5), pp. 102111. Date of Electronic Publication: 2023 Mar 15.
DOI: 10.1016/j.clinre.2023.102111
Abstrakt: Background: The pharmacologic treatment of non-alcoholic fatty liver disease (NAFLD) remains unclear.
Methods: Two reviewers searched PubMed, SCOPUS, Cochrane Central and clinicaltrials.gov for randomized controlled trials (RCTs) of patients with NAFLD with or without type 2 diabetes mellitus (T2DM) receiving TZDs vs SGLT2 inhibitors. The primary outcomes were change in alanine aminotransferase (ALT), aspartate aminotransferase (AST) and gamma-glutamyl transferase (GGT) and improvement in steatosis and fibrosis. The secondary outcomes were changes in lipid profile, body weight and glycated hemoglobin (HbA1c). Random effects models with continuous outcomes as weighted mean differences (WMD) with 95% confidence intervals (CI) were used.
Results: Five studies (n = 311 NAFLD patients) were included. Patients treated with SGLT2 inhibitors (n = 156) showed significant decrease in visceral fat area (VFA; WMD 23.45, p < 0.00001) and body weight (WMD 4.22, p < 0.00001) as compared to those treated with TZDs (n = 155). Patients from both groups showed improvement in AST (WMD 1.21, p = 0.40), ALT (WMD -0.46, p = 0.81), GGT (WMD -0.47, p = 0.84), hepatic fibrosis (WMD 0.11, p = 0.52), LDL (WMD 2.19, p = 0.35), HbA1c (WMD -0.16%, p = 0.20), HOMA-IR (WMD: -0.04, p = 0.91) and FPG (WMD -7.37, p = 0.28) which was equivalent and non-significant.
Conclusion: The improvement in liver enzymes, steatosis and fibrosis caused by SGLT2 inhibitors and TZDs was similar. SGLT2 inhibitors, however, resulted in a significant decrease in VFA and body weight. As weight loss is found to have a positive effect on the resolution of steatosis and fibrosis in NAFLD patients, SGLT2 inhibitors may have the potential to be considered for long-term management, however, further research needs to be conducted to determine the utility of SGLT2 inhibitor class of antidiabetic drugs for effectively treating NAFLD.
Competing Interests: Declaration of Competing Interest The authors have no relevant financial or non-financial interests to disclose.
(Copyright © 2023 Elsevier Masson SAS. All rights reserved.)
Databáze: MEDLINE
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