Systematic review with network meta-analysis: comparative efficacy of pharmacologic therapies for fibrosis improvement and resolution of NASH.
Journal
Alimentary pharmacology & therapeutics
ISSN: 1365-2036
Titre abrégé: Aliment Pharmacol Ther
Pays: England
ID NLM: 8707234
Informations de publication
Date de publication:
10 2021
10 2021
Historique:
revised:
02
07
2021
received:
26
05
2021
accepted:
14
08
2021
pubmed:
27
8
2021
medline:
18
9
2021
entrez:
26
8
2021
Statut:
ppublish
Résumé
Nonalcoholic steatohepatitis (NASH) is a common cause of chronic liver disease. There is a major need to understand the efficacy of different pharmacological agents for the treatment of NASH. To assess the relative rank-order of different pharmacological interventions in fibrosis improvement and NASH resolution. A comprehensive search of several databases was conducted by an experienced librarian. We included randomised controlled-trials (RCTs) comparing pharmacological interventions in patients with biopsy-proven NASH. The primary outcome was ≥1 stage improvement in fibrosis. The secondary outcome was NASH resolution. A total of 26 RCTs with 23 interventions met the eligibility criteria. Lanifibranor and obeticholic acid had the highest probability of being ranked the most effective intervention for achieving ≥1 stage of fibrosis improvement (SUCRA 0.78) and (SUCRA 0.77), respectively. For NASH resolution, semaglutide, liraglutide and vitamin E plus pioglitazone had the highest probability of being ranked the most effective intervention for achieving NASH resolution (SUCRA 0.89), (SUCRA 0.84) and (SUCRA 0.83), respectively. Lanifibranor, obeticholic acid, pioglitazone and vitamin E were significantly better than placebo in achieving ≥1 stage of fibrosis improvement. Conversely, semaglutide, liraglutide, vitamine E plus pioglitazone, pioglitazone, lanifibranor and obeticholic acid were significantly better than placebo in achieving NASH resolution. These data provide relative rank-order efficacy of various NASH therapies in terms of their improvements in liver fibrosis and NASH resolution. Therapies that have been shown to improve NASH resolution may be combined with therapies that have an antifibrotic effect to further boost treatment response rate in future.
Sections du résumé
BACKGROUND
Nonalcoholic steatohepatitis (NASH) is a common cause of chronic liver disease. There is a major need to understand the efficacy of different pharmacological agents for the treatment of NASH.
AIM
To assess the relative rank-order of different pharmacological interventions in fibrosis improvement and NASH resolution.
METHODS
A comprehensive search of several databases was conducted by an experienced librarian. We included randomised controlled-trials (RCTs) comparing pharmacological interventions in patients with biopsy-proven NASH. The primary outcome was ≥1 stage improvement in fibrosis. The secondary outcome was NASH resolution.
RESULTS
A total of 26 RCTs with 23 interventions met the eligibility criteria. Lanifibranor and obeticholic acid had the highest probability of being ranked the most effective intervention for achieving ≥1 stage of fibrosis improvement (SUCRA 0.78) and (SUCRA 0.77), respectively. For NASH resolution, semaglutide, liraglutide and vitamin E plus pioglitazone had the highest probability of being ranked the most effective intervention for achieving NASH resolution (SUCRA 0.89), (SUCRA 0.84) and (SUCRA 0.83), respectively. Lanifibranor, obeticholic acid, pioglitazone and vitamin E were significantly better than placebo in achieving ≥1 stage of fibrosis improvement. Conversely, semaglutide, liraglutide, vitamine E plus pioglitazone, pioglitazone, lanifibranor and obeticholic acid were significantly better than placebo in achieving NASH resolution.
CONCLUSION
These data provide relative rank-order efficacy of various NASH therapies in terms of their improvements in liver fibrosis and NASH resolution. Therapies that have been shown to improve NASH resolution may be combined with therapies that have an antifibrotic effect to further boost treatment response rate in future.
Identifiants
pubmed: 34435378
doi: 10.1111/apt.16583
pmc: PMC8711247
mid: NIHMS1733557
doi:
Substances chimiques
Vitamin E
1406-18-4
Pioglitazone
X4OV71U42S
Types de publication
Journal Article
Meta-Analysis
Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, Non-P.H.S.
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
880-889Subventions
Organisme : NIDDK NIH HHS
ID : U01DK061734
Pays : United States
Organisme : NCATS NIH HHS
ID : 5UL1TR001442
Pays : United States
Organisme : NIDDK NIH HHS
ID : R01DK121378
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1 TR001442
Pays : United States
Organisme : NIEHS NIH HHS
ID : P42 ES010337
Pays : United States
Organisme : NIDDK NIH HHS
ID : R01DK124318
Pays : United States
Organisme : NIDDK NIH HHS
ID : P30 DK120515
Pays : United States
Organisme : NIDDK NIH HHS
ID : R01 DK124318
Pays : United States
Organisme : NIDDK NIH HHS
ID : P30DK120515
Pays : United States
Organisme : NIDDK NIH HHS
ID : U01 DK061734
Pays : United States
Organisme : NHLBI NIH HHS
ID : P01HL147835
Pays : United States
Organisme : NHLBI NIH HHS
ID : P01 HL147835
Pays : United States
Organisme : NIDDK NIH HHS
ID : R01 DK121378
Pays : United States
Organisme : NIDDK NIH HHS
ID : R01 DK106419
Pays : United States
Organisme : NIEHS NIH HHS
ID : 5P42ES010337
Pays : United States
Organisme : NIDDK NIH HHS
ID : R01DK106419
Pays : United States
Organisme : NIAAA NIH HHS
ID : U01AA029019
Pays : United States
Informations de copyright
© 2021 John Wiley & Sons Ltd.
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