Hassan Mona, Al-Obaidi Hasan, Karrick Megan, Merza Nooraldin, Nawras Yusuf, Saab Omar, Al-Obaidi Ahmed Dheyaa, Merza Fatima, Hashim Hashim Talib, Al Zubaidi Khalid, Al-Sabbagh Daniah, Matbachi Rand, Noori Zainab, Amatul-Raheem Hajra, Mansur Sarmad, Al Najafi Omer, Algodi Marwah, Al Hamdany Tamarah, Kobeissy Abdallah
Gastroenterology and Hepatology Department, The University of Toledo, Toledo, OH, USA.
Internal Medicine Department, Jamaica Hospital Medicine Center, Queens, NY, USA.
Gastroenterology Res. 2024 Aug;17(4):159-174. doi: 10.14740/gr1750. Epub 2024 Aug 31.
Metabolic dysfunction-associated steatotic liver disease (MASLD) and metabolic dysfunction-associated steatohepatitis (MASH) are prevalent conditions linked to obesity and metabolic disturbances, with potential complications such as cirrhosis and cardiovascular risks. This systematic review and meta-analysis aimed to evaluate the efficacy of pemafibrate, a drug targeting fat and sugar metabolism genes, in treating patients with MASLD/MASH.
Databases such as MEDLINE, Web of Science, Cochrane Library, and Scopus were searched until September 2023 to identify relevant studies. Selected studies underwent a thorough quality assessment using tools like Risk of Bias 2 tool (ROB-2) and the National Institutes of Health (NIH) Quality Assessment Tools. Comprehensive meta-analysis software was used for statistical evaluations, with a focus on lipid profiles, liver function tests, and fibrosis measurements.
A total of 13 studies were included; 10 of them were included in the quantitative analysis. Our findings showed that pemafibrate significantly decreased low-density lipoprotein cholesterol (LDL-C) (effect size (ES) = -9.61 mg/dL, 95% confidence interval (CI): -14.15 to -5.08), increased high-density lipoprotein cholesterol (HDL-C) (ES = 3.15 mg/dL, 95% CI: 1.53 to 4.78), and reduced triglycerides (TG) (ES = -85.98 mg/dL, 95% CI: -96.61 to -75.36). Additionally, pemafibrate showed a marked reduction in liver enzyme levels, including aspartate aminotransferase (AST), alanine aminotransferase (ALT), γ-glutamyl transpeptidase (GGT), and alkaline phosphatase (ALP), with significant effect sizes and P values. For liver stiffness outcomes, pemafibrate decreased AST to platelet ratio index (APRI) (ES = -0.180, 95% CI: -0.221 to -0.138).
Pemafibrate, with its enhanced efficacy and safety profile, presents as a pivotal agent in MASLD/MASH treatment. Its lipid-regulating properties, coupled with its beneficial effects on liver inflammation markers, position it as a potentially invaluable therapeutic option.
代谢功能障碍相关脂肪性肝病（MASLD）和代谢功能障碍相关脂肪性肝炎（MASH）是与肥胖和代谢紊乱相关的常见病症，存在诸如肝硬化和心血管风险等潜在并发症。本系统评价和荟萃分析旨在评估培马贝特（一种靶向脂肪和糖代谢基因的药物）治疗MASLD/MASH患者的疗效。
检索MEDLINE、科学网、考克兰图书馆和Scopus等数据库直至2023年9月，以识别相关研究。使用偏倚风险2工具（ROB-2）和美国国立卫生研究院（NIH）质量评估工具等对所选研究进行全面质量评估。使用综合荟萃分析软件进行统计评估，重点关注血脂谱、肝功能检查和纤维化测量。
共纳入13项研究；其中10项纳入定量分析。我们的研究结果表明，培马贝特显著降低低密度脂蛋白胆固醇（LDL-C）（效应量（ES）=-9.61mg/dL，95%置信区间（CI）：-14.15至-5.08），升高高密度脂蛋白胆固醇（HDL-C）（ES = 3.15mg/dL，95%CI：1.53至4.78），并降低甘油三酯（TG）（ES = -85.98mg/dL，95%CI：-96.61至-75.36）。此外，培马贝特还显著降低了肝酶水平，包括天冬氨酸转氨酶（AST）、丙氨酸转氨酶（ALT）、γ-谷氨酰转肽酶（GGT）和碱性磷酸酶（ALP），具有显著的效应量和P值。对于肝脏硬度结果，培马贝特降低了AST与血小板比值指数（APRI）（ES = -0.180，95%CI：-0.221至-0.138）。
培马贝特具有增强的疗效和安全性，是MASLD/MASH治疗中的关键药物。其调节血脂的特性，以及对肝脏炎症标志物的有益作用，使其成为一种潜在的极具价值的治疗选择。
