新型抗糖尿病药物治疗非酒精性脂肪性肝病：随机对照试验的系统评价和网络荟萃分析。

New anti-diabetic agents for the treatment of non-alcoholic fatty liver disease: a systematic review and network meta-analysis of randomized controlled trials.

机构信息

Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.

Siriraj Health Policy Unit, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.

出版信息

Front Endocrinol (Lausanne). 2023 Jun 27;14:1182037. doi: 10.3389/fendo.2023.1182037. eCollection 2023.

DOI:10.3389/fendo.2023.1182037

PMID:37441498

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10335801/

Abstract

OBJECTIVES

This network meta-analysis aims to compare the efficacy and safety of new anti-diabetic medications for the treatment of non-alcoholic fatty liver disease (NAFLD).

MATERIALS AND METHODS

PubMed and Scopus were searched from inception to 27 March 2022 to identify all randomized controlled trials (RCTs) in NAFLD patients. Outcomes included reductions in intrahepatic steatosis (IHS) and liver enzyme levels. The efficacy and safety of DPP-4 inhibitors, GLP-1 agonists, SGLT-2 inhibitors, and other therapies were indirectly compared using a NMA approach. Unstandardized mean difference (USMD) with 95% confidence intervals (CI) were calculated.

RESULTS

2,252 patients from 31 RCTs were included. "Add-on" GLP-1 agonists with standard of care (SoC) treatment showed significantly reduced IHS compared to SoC alone [USMD (95%CI) -3.93% (-6.54%, -1.33%)]. Surface under the cumulative ranking curve (SUCRA) identified GLP-1 receptor agonists with the highest probability to reduce IHS (SUCRA 88.5%), followed by DPP-4 inhibitors (SUCRA 69.6%) and pioglitazone (SUCRA 62.2%). "Add-on" GLP-1 receptor agonists were also the most effective treatment for reducing liver enzyme levels; AST [USMD of -5.04 (-8.46, -1.62)], ALT [USMD of -9.84 (-16.84, -2.85)] and GGT [USMD of -15.53 (-22.09, -8.97)] compared to SoC alone. However, GLP-1 agonists were most likely to be associated with an adverse event compared to other interventions.

CONCLUSION

GLP-1 agonists may represent the most promising anti-diabetic treatment to reduce hepatic steatosis and liver enzyme activity in T2DM and NAFLD patients. Nevertheless, longer-term studies are required to determine whether this delays progression of liver cirrhosis in patients with NAFLD and T2DM.

SYSTEMATIC REVIEW REGISTRATION

https://www.crd.york.ac.uk/prospero/, identifier CRD42021259336.1.

摘要

目的

本网络荟萃分析旨在比较新型抗糖尿病药物治疗非酒精性脂肪性肝病（NAFLD）的疗效和安全性。

材料和方法

从建库到 2022 年 3 月 27 日，在 PubMed 和 Scopus 中检索所有 NAFLD 患者的随机对照试验（RCT）。结局包括肝内脂肪变性（IHS）和肝酶水平的降低。使用 NMA 方法间接比较 DPP-4 抑制剂、GLP-1 激动剂、SGLT-2 抑制剂和其他治疗的疗效和安全性。使用未标准化均数差（USMD）和 95%置信区间（CI）进行计算。

结果

纳入 31 项 RCT 的 2252 名患者。与单独标准治疗（SoC）相比，“附加”GLP-1 激动剂联合 SoC 治疗可显著降低 IHS [USMD（95%CI）-3.93%（-6.54%，-1.33%）]。累积排序曲线下面积（SUCRA）确定 GLP-1 受体激动剂降低 IHS 的可能性最高（SUCRA 88.5%），其次是 DPP-4 抑制剂（SUCRA 69.6%）和吡格列酮（SUCRA 62.2%）。“附加”GLP-1 受体激动剂也是降低肝酶水平最有效的治疗方法；AST[USMD-5.04（-8.46，-1.62）]、ALT[USMD-9.84（-16.84，-2.85）]和 GGT[USMD-15.53（-22.09，-8.97）]与单独 SoC 相比。然而，与其他干预措施相比，GLP-1 激动剂最有可能与不良事件相关。