The Effects of Testosterone Replacement Therapy in Adult Men with Metabolic Dysfunction associated Steatotic Liver Disease: A Systematic Review and Meta-analysis.

IF 3 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Clinical and Translational Gastroenterology Pub Date : 2024-11-06 DOI:10.14309/ctg.0000000000000787
Maya Mahmoud, Hassan Kawtharany, Mohamed Awali, Nadine Mahmoud, Islam Mohamed, Wing-Kin Syn
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Abstract

Background: Sex steroids modulate metabolic-dysfunction associated steatotic liver disease (MASLD) pathobiology. We hypothesized that testosterone therapy (TT) modulates progression of MASLD, and performed a systematic review to evaluate the efficacy of TT on liver steatosis and fibrosis.

Methods: We searched PubMed and Embase from inception until November 2023. We screened 1489 studies and identified 9 eligible studies. We assessed risk of bias for randomized trials using RoB-2 "Cochrane risk of bias tool for randomized trials", non-randomized studies using ROBINS-I tool "Risk of Bias in Non-randomized Studies-of Interventions", and Murad's Tool for single-arm studies. We pooled estimates using RevMan 5.

Results: 3 randomized controlled trials (RCTs), 4 non-randomized studies, and 2 single-arm studies were identified. The population of interest comprised men with MASLD. TT was administered at varying doses, routes, and frequencies, with follow-up ranging 12-weeks to 8-years. Liver fibrosis and steatosis were assessed using liver biopsy in 3 studies, CT/MRI in 5, and serum scores in 2. All studies provided evidence of reduction in liver steatosis with TT compared to no TT. In addition, the LiFT (RCT) trial demonstrated a resolution of MASLD / MASH and a regression in liver fibrosis. TT led to decrease in liver enzymes. Studies were heterogenous in terms of population characteristics, treatment modalities, endpoints, and follow-up. Adverse events were comparable between the 2 groups.

Conclusion: TT is a promising treatment option for men with MASLD and low testosterone. It may improve liver steatosis and reduce liver fibrosis. Large, double-blinded randomized placebo-controlled trials are needed.

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睾酮替代疗法对代谢功能障碍伴有脂肪肝的成年男性的影响:系统回顾与元分析》。
背景:性类固醇可调节代谢功能障碍相关性脂肪性肝病(MASLD)的病理生物学。我们假设睾酮疗法(TT)可调节MASLD的进展,并进行了一项系统性综述,以评估TT对肝脏脂肪变性和纤维化的疗效:我们检索了从开始到 2023 年 11 月的 PubMed 和 Embase。我们筛选了 1489 项研究,确定了 9 项符合条件的研究。我们使用RoB-2 "Cochrane随机试验偏倚风险工具 "评估了随机试验的偏倚风险,使用ROBINS-I工具 "非随机干预研究的偏倚风险 "评估了非随机研究的偏倚风险,使用Murad工具评估了单臂研究的偏倚风险。我们使用 RevMan 5.Results 对估计结果进行了汇总:结果:确定了 3 项随机对照试验 (RCT)、4 项非随机研究和 2 项单臂研究。研究对象包括患有 MASLD 的男性。TT的给药剂量、途径和频率各不相同,随访时间从12周到8年不等。有 3 项研究使用肝活检、5 项研究使用 CT/MRI、2 项研究使用血清评分对肝纤维化和脂肪变性进行了评估。此外,LiFT(RCT)试验表明,MASLD/MASH 已得到缓解,肝纤维化也有所减轻。TT 可降低肝酶。这些研究在人群特征、治疗方式、终点和随访方面存在差异。两组研究的不良事件具有可比性:TT对于患有MASLD和低睾酮的男性来说是一种很有前景的治疗选择。结论:TT 对患有 MASLD 和低睾酮症的男性来说是一种很有前景的治疗方案,它可以改善肝脏脂肪变性并减轻肝纤维化。需要进行大型双盲随机安慰剂对照试验。
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来源期刊
Clinical and Translational Gastroenterology
Clinical and Translational Gastroenterology GASTROENTEROLOGY & HEPATOLOGY-
CiteScore
7.00
自引率
0.00%
发文量
114
审稿时长
16 weeks
期刊介绍: Clinical and Translational Gastroenterology (CTG), published on behalf of the American College of Gastroenterology (ACG), is a peer-reviewed open access online journal dedicated to innovative clinical work in the field of gastroenterology and hepatology. CTG hopes to fulfill an unmet need for clinicians and scientists by welcoming novel cohort studies, early-phase clinical trials, qualitative and quantitative epidemiologic research, hypothesis-generating research, studies of novel mechanisms and methodologies including public health interventions, and integration of approaches across organs and disciplines. CTG also welcomes hypothesis-generating small studies, methods papers, and translational research with clear applications to human physiology or disease. Colon and small bowel Endoscopy and novel diagnostics Esophagus Functional GI disorders Immunology of the GI tract Microbiology of the GI tract Inflammatory bowel disease Pancreas and biliary tract Liver Pathology Pediatrics Preventative medicine Nutrition/obesity Stomach.
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