Pioglitazone versus metformin in Egyptian non diabetic patients with Non Alcholic Fatty Liver Disease: A randomized controlled trial.

NAFLD is estimated to be the most common cause of chronic liver disease and there are increasing rates of NASH-related liver transplantation. This study evaluates the effect of two different insulin sensitizers, pioglitazone and metformin, on liver fat content, lipolysis and insulin sensitivity in Egyptian patients with non alcoholic fatty liver disease. Forty Egyptian patients with fatty liver were enrolled in a six-month prospective study. The patients were recruited from outpatient clinics of Department of Internal Medicine, Tanta University Hospitals with ultrasonographic diagnosis of fatty liver. The patients were randomly divided into two groups; Group I (pioglitazone group) was treated by 45 mg pioglitazone/day and Group II (metformin group) was treated by metformin 20mg/kg/day. A third group of healthy subjects served as control group. The study indicated that both antihyperglycemic drugs decreased homeostatic model assessment-insulin resistance (p<0.01), plasma free fatty acids (p<0.01) and liver fat content (p<0.01) associated with improvement of hyperechogenicity in liver ultrasound in both the pioglitazone group (p<0.001) and the metformin group (p=0.47). Both treatments also improved serum levels of alanine aminotransferase (p<0.01), aspartate aminotransferase (p<0.01), high density lipoprotein–cholesterol (p<0.01) and adiponectin (p<0.01). The insulin sensitizers pioglitazone and metformin exhibited a beneficial role in management of NAFLD. Meanwhile, pioglitazone was superior to metformin in improving liver stestosis and could provide a therapeutic option to guard against disease complications.