Comparative efficacy of glucagon-like peptide 1 (GLP-1) receptor agonists, pioglitazone and vitamin E for liver histology among patients with nonalcoholic fatty liver disease: systematic review and pilot network meta-analysis of randomized controlled trials

source extracted confidence: high 2026-04-09
#humans #diabetes-mellitus-type-2 #glucagon-like-peptide-1 #glucagon-like-peptide-1-receptor #hypoglycemic-agents

Comparative efficacy of glucagon-like peptide 1 (GLP-1) receptor agonists, pioglitazone and vitamin E for liver histology among patients with nonalcoholic fatty liver disease: systematic review and pilot network meta-analysis of randomized controlled trials

Gu et al., 2023 | Expert Rev Gastroenterol Hepatol | Systematic Review

Citation

Gu Yunpeng, Sun Lei, ... Shi Junping. Comparative efficacy of glucagon-like peptide 1 (GLP-1) receptor agonists, pioglitazone and vitamin E for liver histology among patients with nonalcoholic fatty liver disease: systematic review and pilot network meta-analysis of randomized controlled trials. Expert Rev Gastroenterol Hepatol. 2023-Mar;17(3):273-282. doi:10.1080/17474124.2023.2172397

Abstract

INTRODUCTION: There is no conclusive evidence comparing the efficacy of glucagon-like peptide 1 (GLP-1) receptor agonists to the other guidelines recommended pharmacotherapy for nonalcoholic fatty liver disease (NAFLD). Therefore, we aim to compare the effects of GLP-1 receptor agonists, pioglitazone and vitamin E in patients with NAFLD. METHODS: We searched PubMed, Embase, Web of Science and Cochrane Library up to 11 April 2022. Randomized clinical trials (RCTs) comparing GLP-1 receptor agonists, pioglitazone and vitamin E against placebo or other active controls in patients with NAFLD were included. RESULTS: Nine RCTs including 1482 patients proved eligible. GLP-1 receptor agonists ranked first in steatosis, ballooning necrosis, γ-glutamyl transferase, body weight, body mass index, and triglycerides. Administration of GLP-1 receptor agonists, as compared with placebo, was associated with improvement in liver histology [steatosis (OR = 4.11, 95% CI: 2.83, 5.96), ballooning necrosis (OR = 3.07, 95% CI: 2.14, 4.41), lobular inflammation (OR = 1.86, 95% CI: 1.29, 2.68), fibrosis (OR = 1.52, 95% CI: 1.06, 2.20)]. CONCLUSIONS: GLP-1 receptor agonists were as effective as pioglitazone and vitamin E for liver histology among patients with NAFLD. GLP-1 receptor agonists might be considered as an alternative or complementary treatment in the future clinical practice. [Figure: see text].

Key Findings

Nine RCTs including 1482 patients proved eligible. GLP-1 receptor agonists ranked first in steatosis, ballooning necrosis, γ-glutamyl transferase, body weight, body mass index, and triglycerides. Administration of GLP-1 receptor agonists, as compared with placebo, was associated with improvement in liver histology [steatosis (OR = 4.11, 95% CI: 2.83, 5.96), ballooning necrosis (OR = 3.07, 95% CI: 2.14, 4.41), lobular inflammation (OR = 1.86, 95% CI: 1.29, 2.68), fibrosis (OR = 1.52, 95% CI: 1.06

Outcomes Measured

  • Requires manual extraction

Population

Field Value
Population nafld
Sample Size 1482
Age Range See abstract
Condition inflammation

MeSH Terms

  • Humans
  • Diabetes Mellitus, Type 2
  • Glucagon-Like Peptide 1
  • Glucagon-Like Peptide-1 Receptor
  • Hypoglycemic Agents
  • Necrosis
  • Non-alcoholic Fatty Liver Disease
  • Pioglitazone
  • Randomized Controlled Trials as Topic
  • Vitamin E
  • Pilot Projects
  • Glucagon-Like Peptide-1 Receptor Agonists

Evidence Classification

  • Level: Systematic Review
  • Publication Types: Comparative Study, Journal Article, Systematic Review, Network Meta-Analysis
  • Vertical: vitamin-e-liver

Provenance

Source extracted via PubMed E-utilities API on 2026-04-09