Efficacy of Hypoglycemic Agents in Metabolic Dysfunction Associated Steatotic Liver Disease (MASLD): A Systematic Review and Network Meta-Analysis

IF 3.5 2区医学 Q1 MEDICINE, GENERAL & INTERNAL Journal of Evidence‐Based Medicine Pub Date : 2025-04-14 DOI:10.1111/jebm.70021

Qiao Ren, Yao Tan, Guixiang Zhang, Yuzhao Dai, Lidan Yang, Yunmo Wu, He He, Jie Chen

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Abstract

Aims

Metabolic dysfunction associated steatotic liver disease (MASLD) is a universal hepatic disease, and many recent randomized clinical trials (RCTs) have explored whether hypoglycemic agents may be beneficial for its treatment. This study aimed to assess the relative effectiveness of each hypoglycemic agent for MASLD.

Methods

China National Knowledge Infrastructure（CNKI）, WanFang, Weipu, PubMed, Embase, The Cochrane Library, and Web of Science Core Collection were searched for RCTs on the efficacy of hypoglycemic agents in MASLD published up to December 31, 2024. All statistical analyses were performed using R version 4.3.3. The network meta-analysis was conducted using Bayesian statistical methods.

Results

A total of 26 hypoglycemic agents for treating MASLD in 37 studies with 2406 participants were included. Empagliflozin was most effective in improving liver stiffness measurement (LSM), whereas liraglutide showed significant benefits in body weight, body mass index (BMI), and waist circumference. Both sodium-glucose co-transporter 2 (SGLT-2) inhibitors (e.g., empagliflozin) and glucagon-like peptide-1 (GLP-1) receptor agonists (e.g., liraglutide) improved liver enzymes (alanine aminotransferase [ALT], aspartate aminotransferase [AST], gamma-glutamyltransferase [GGT]), glucose metabolism (fasting plasma glucose [FPG], and homeostasis model assessment of insulin resistance [HOMA-IR]), and lipid profiles. Pioglitazone had limited benefits in these outcomes. Secondary outcomes such as inflammatory markers and fibrosis showed minimal changes.

Conclusions

Several hypoglycemic agents can improve laboratory and imaging indicators in adult patients with MASLD. Liraglutide is more effective than other agents, whereas empagliflozin emerged as the most effective for reducing LSM. However, different agents have different effects on the indicators; therefore, the relevant agents must be selected according to the specific patient condition.

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降糖药对代谢功能障碍相关脂肪变性肝病（MASLD）的疗效：系统评价和网络荟萃分析

目的代谢功能障碍相关脂肪变性肝病（MASLD）是一种普遍的肝脏疾病，近年来许多随机临床试验（RCTs）探讨了降糖药是否有益于其治疗。本研究旨在评估各种降糖药对MASLD的相对疗效。方法检索中国知网（CNKI）、万方、唯普、PubMed、Embase、The Cochrane Library、Web of Science Core Collection截至2024年12月31日发表的关于降糖药治疗MASLD疗效的随机对照试验。所有统计分析均使用R 4.3.3版本进行。网络meta分析采用贝叶斯统计方法。结果37项研究共纳入26种降糖药治疗MASLD，受试者2406人。恩格列净在改善肝硬度测量（LSM）方面最有效，而利拉鲁肽在体重、体重指数（BMI）和腰围方面显示出显著的益处。钠-葡萄糖共转运蛋白2 （SGLT-2）抑制剂（如恩格列净）和胰高血糖素样肽-1 （GLP-1）受体激动剂（如利拉鲁肽）均可改善肝酶（谷氨酸转氨酶[ALT]、天冬氨酸转氨酶[AST]、γ -谷氨酰转移酶[GGT]）、葡萄糖代谢（空腹血糖[FPG]和胰岛素抵抗的稳态模型评估[HOMA-IR]）和脂质谱。吡格列酮在这些结果中的益处有限。次要结果，如炎症标志物和纤维化显示最小的变化。结论几种降糖药可改善成人MASLD患者的实验室和影像学指标。利拉鲁肽比其他药物更有效，而恩格列净对降低LSM最有效。但不同药剂对指标的影响不同；因此，必须根据患者的具体情况选择相关的药物。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Evidence‐Based Medicine MEDICINE, GENERAL & INTERNAL-

CiteScore

11.20

自引率

1.40%

发文量

期刊介绍： The Journal of Evidence-Based Medicine (EMB) is an esteemed international healthcare and medical decision-making journal, dedicated to publishing groundbreaking research outcomes in evidence-based decision-making, research, practice, and education. Serving as the official English-language journal of the Cochrane China Centre and West China Hospital of Sichuan University, we eagerly welcome editorials, commentaries, and systematic reviews encompassing various topics such as clinical trials, policy, drug and patient safety, education, and knowledge translation.